Ask the Doctors May 2003 Issue

Ask Dr. Marks: 05/03

What is inflammatory arthritis? I thought only rheumatoid arthritis was inflammatory.

There are two major families of arthritis: "wear and tear" or degenerative arthritis, and inflammatory arthritis. The prototype for degenerative arthritis is osteoarthritis. The prototype for inflammatory arthritis is rheumatoid arthritis. Although a prototype, rheumatoid arthritis is only one of a large group of conditions that causes inflammation and pain within the joint. Other forms of inflammatory arthritis are psoriatic arthritis, Reiter's syndrome and connective-tissue diseases (lupus, sclerosis). All inflammatory arthritis begins in the lining of the joint, called the synovium. The synovium becomes inflamed and releases enzymes and chemical mediators which, in turn, attack the cartilage. Contrast this to degenerative arthritis, which begins with the wearing out of a joint, which sometimes causes a secondary inflammation within the joint. Rheumatoid arthritis and osteoarthritis are two different conditions that can be differentiated by your doctor through blood tests and X-rays.


What is the best time to take a one-dose-a-day drug?

A once-a-day drug is best taken during a meal or just after a meal. Breakfast and dinner are the most common meals during which arthritis sufferers take these drugs. It makes little difference which meal you chose. It is important, however, to be consistent. If you're a person who frequently skips breakfast, then itís best to take your medication at dinner-time. Symptoms also play a role when you take your drug. If you have morning symptoms, it may be best to take a one-dose-a-day in the morning.


How can I avoid the side effects of arthritis medication?

Generally, you should take the minimum dose required to obtain relief from your arthritis symptoms. You should avoid unnecessary use of medications for minimal symptoms. You should also avoid taking multiple medications for the same reasons. Do not take two NSAIDs at the same time. Also, you should take NSAIDs with food, which will minimize gastric irritation. Importantly, you should report any gastrointestinal problems caused by NSAIDs to your doctor. He may wish to change the dosage, the type of medication, or add a protective medication to your regimen.


I've read that NSAIDs interfere with cartilage formation. Why should I take an analgesic that worsens the condition underlying the pain?

By the time NSAIDs are necessary for pain relief, the cartilage may have already undergone irreversible damage, which will lead to severe osteoarthritis with or without NSAID medication. Although NSAIDs may negatively impact chondrocyte or cartilage cell metabolism in laboratories or in vitro testing, it may not be important in a clinical situation.