Once the diagnosis is made, treatment of arthritis should begin as soon as possible to prevent or at least delay damage to the joints. The therapy is initially based on the underlying disease. In the case of infection-related arthritis, for example, the infection is combated with antibiotics or antiviral or fungal drugs, depending on the pathogen.
Arthritis caused by gout can be treated by taking uric acid-lowering drugs such as allopurinol. In autoimmune arthritis, the therapy is based on the suppression of the immune response (immunosuppressive drugs). As a rule, cortisone or drugs similar to cortisone (glucocorticoids) are initially used.
If a single joint is affected by a severe inflammation, cortisone can also be injected directly into the joint. This has the advantage that fewer side effects occur throughout the entire organism, as the drug only acts locally in the joint. In severe cases of autoimmune diseases, stronger immunosuppressive drugs such as leflunomide or methotrexate are used.
The latter is used in high doses as chemotherapy for cancer, but the dose commonly used to treat arthritis is much lower and therefore has fewer side effects. In the long-term treatment of rheumatoid arthritis, these drugs are known as basic therapeutic agents or DMARDs – disease-modifying antirheumatic drugs – because they intervene specifically in the course of the disease. They prevent the progression of the disease and can avoid late effects if the therapy is started in time.
However, it can take up to several months before the effect is felt. In the initial phase, cortisone is therefore given additionally, whereby the dose can often be reduced once the DMARDs take effect. A new group of DMARDs are the so-called biologicals.
These are genetically engineered proteins that act against certain inflammatory substances or inflammation-promoting immune cells. They often act faster than the conventional DMARDs and are often used in patients who have not had any other therapy. For pain, anti-inflammatory painkillers (NSAIDs, non-steroidal anti-inflammatory drugs) such as Diclofenac can be taken as required for all forms of arthritis. Physiotherapy and physical treatments such as cold therapy or electrotherapy can help to reduce the pain and improve mobility.
Late effects and prognosis
Whereas patients with arthritis used to be recognizable by their severely deformed hands, nowadays such late effects can be avoided in many cases by early therapy. Untreated, arthritis leads to the destruction of cartilage and bone due to the chronic inflammation of the synovial membrane. This restricts or even completely prevents mobility.
In the long term, the joint loses its function and becomes stiff. Since tendons and surrounding soft tissue can also be affected, deformations and malpositions can occur. If the arthritis is diagnosed in time and treated accordingly, the disease can usually be controlled well today. Nevertheless, patients should seek support in the form of training, self-help groups or occupational therapy in order to better cope with everyday life with the disease.