HEALTH / Common Remedies: Drugs for Arthritis

THE problem in writing about drugs for arthritis is that there aren't any - or at least not in the sense that there are antibiotics to cure infections. The common sort of arthritis - osteoarthritis or osteoarthrosis - is caused by repeated injuries and ageing damaging the surfaces of joints, and no drugs have yet been found that will reverse that process.

Yet drugs for arthritis are at the top of the league table of prescriptions, both in numbers and in the amount of money they earn for the pharmaceutical industry. Every day millions of people in Britain take their arthritis drugs to relieve some of the pain and stiffness in their joints, but these drugs hold out no prospect whatever of a cure. They are, however, effective in what they set out to do - to damp down the effects of inflammation in and around the joints.

In some types of arthritis, such as gout and rheumatoid arthritis, inflammation is a prominent feature of the illness. The joints of people with ordinary wear and tear arthritis are usually not so dramatically inflamed, but they can flare up from time to time.

An inflamed joint is hot, red, swollen and painful as a result of chemicals being released from the cells of the immune system. The most important of the inflammation- inducing chemicals are the prostaglandins. Drugs which block the formation of prostaglandins reduce the severity of inflammation and also relieve pain.

For most of this century the best drug for treating the inflammation and pain of arthritis has been aspirin; but allergic reactions are common, it irritates the stomach (and may cause internal bleeding), and given in high doses it may cause deafness. So the pharmaceutical industry has invested vast amounts of money in looking for an alternative.

Steroids are the most powerful of all anti-inflammatory drugs, but their side-

effects rule them out in most circumstances. The drugs in common use are called non-steroidal anti-inflammatory drugs, or NSAIDS. Phenylbutazone and oxyphenbutazone were early examples. They are highly effective, but as well as upsetting the stomach they may cause life-threatening damage to the bone marrow and are now used only in special circumstances. Ibuprofen and half a dozen others with names ending in -profen are well established as alternatives to aspirin that do seem kinder to the stomach, but they may still cause indigestion. How individuals react is unpredictable; each person has to experiment to find which of the drugs suits him or her best. Two or three other groups of NSAIDS have different patterns of side-effects and again each individual has to try for himself to find one which relieves symptoms without any major drawbacks.

The fact that 30 or so drugs of this kind are in current use is clear evidence that none is ideal, and the best they can achieve is a temporary easing of the symptoms. A few people with severe, progressive rheumatoid or psoriatic arthritis are treated with drugs intended actually to slow or reverse the underlying disease process. The oldest of these drugs is gold, given by injection; the antimalarial drug chloroquine and several drugs which act on the immune system are also used. All these disease-modifying drugs damp down inflammation round the joints; they also help relieve other features of the arthritis such as inflammation of the blood vessels. Their action is slow; the full response may be delayed for as long as six months and they do not work for all.

All these drugs have potentially serious side-effects, and are used only for patients with progressive, destructive arthritis. Advances in the development of man-made replacement joints offer a radical alternative for people who are severely disabled. Sadly, the underfunded NHS has been unable to meet the steadily increasing demand.