Arthritis

Summary

This chapter presents evidence relating to acute therapies for some common arthritic conditions. It discusses the role NSAIDs, acetaminophen (paracetamol), steroids, colchicines, local anesthetics, opioids, and corticotrophin in arthritis. The major arthritides covered are crystal-mediated arthropathy, osteoarthritis (OA), and rheumatoid arthritis (RA). For gouty arthritis, most commentators favor NSAIDs as first-line therapy, but other treatment options (colchicine, corticosteroids, corticotropin [adrenocorticotropic hormone]) are also used. Corticosteroids are generally rated as a second-line therapy for crystal-related arthritis. Most expert reviews and meta-analyses find an unfavorable risk-to-benefit ratio, although some commentators do report occasional utility of the opioids for OA. For patients with OA in the acute care setting, acetaminophen remains a reasonable initial analgesic choice in selected patients. RA and juvenile RA (JRA) are treated with an array of disease-modifying agents that have secondary effects of relieving pain. Systemic or injected glucocorticoids are useful in RA and JRA.