Osteoarthritis vs rheumatoid arthritis treatments | NCLEX-RN | Khan Academy

- [Voiceover] The basic treatments
for rheumatoid arthritis

and osteoarthritis come at it
from very different angles.

I think the key phrase
for rheumatoid arthritis

would be to control.

Shorthand here.

Control it and reduce inflammation.

Remember, this is an autoimmune disease,

so the inflammation comes

from our own immune
system attacking the body.

So if we can temper down this,

oops, that's not a parentheses,

if we can temper down this inflammation,

then we'll really get to
the source of the problem.

But of course we treat the
symptoms of pain as well.

And then on this side for osteoarthritis,

which is the wear-and-tear
degeneration of the cartilage,

our dogma here is gonna be pain control.

Pain control.

And as a bonus, we wanna
work on health in general,

the general state of health,

and increasing the function
and decreasing the symptoms.

Okay, under these very
different umbrellas,

we can only look at one at a time,

on the rheumatoid arthritis side,

we have a class of drugs
called, it's conveniently named,

"Disease-Modifying Antirheumatic drugs."

So, disease, this is gonna be a long name.

Disease-modifying.

So this tells you that it
not only treats the symptoms,

but it also modifies the process,

the progression, of the
disease on the joint.

So modifying antirheumatic,

because when these were first produced,

they were used to treat
rheumatoid arthritis.

But today, they're actually
used to treat all kinds

of autoimmune diseases as well.

So I wanna point out that
there are many different kinds

of drugs that fall under this category.

I'm just gonna put different
X's instead of the names.

And the fact that they all
have different mechanisms.

So they don't actually
attack, or try to temper down,

the inflammation at the same place.

And what puts them together is the fact

that they not only
treat the immune system,

or decrease the inflammation,

but this disease-modifying part tells us

that this group of drugs

decreases joint damage.

As you can see, a lot of the
therapies surrounding arthritis

goes to the symptoms of pain and function,

but this one actually decreases

and slows down the
distortion of the joint.

So there's disease-modifying,
decrease of inflammation,

but then there's also just good, old,

anti-inflammatory drugs that
decreases the inflammation

in the body as a whole.

So it might not target the specific ways

that the joint is damaged,

therefore it's not disease-modifying,

but it also works in terms

of getting the inflammation markers down.

So we have our good, old steroids.

They can be taken by mouth.

What steroids do is that in
the inflammation pathway,

where A leads to B leads to C,

all the way to different
inflammation markers,

steroids comes in in the middle

of this pathway, and just stops it.

So this is effective,
but it's not specific,

and it does not decrease joint damage,

like the D.M.A.R.D.'s do.

And of course, there are N.S.A.I.D.'s.

This is your ibuprofen, your
over-the-counter pain control.

So they're effective in
controlling the pain,

but they also do decrease
the inflammation as well.

So these are the first-line
soldiers fighting the war,

the steroids and N.S.A.I.D.'s,

might be on a case-to-case backup basis.

And then there's just pain control.

All the different, traditional ways

of controlling pain can
be applied here as well.

But hopefully with these two drugs,

we don't need too many
additional pain killers.

So just a side note, really
quick here, about side effects.

If you look at these drugs,
they're anti-inflammatory,

as in they decrease the immune system.

So decreasing the immune system is great

for autoimmune symptoms,

but it also just decreases
our body's defense as well.

So sometimes these drugs, like steroids

of some of the disease-modifying drugs,

can make a person more susceptible

to common things like a cold.

And they might have to
be stopped temporarily

when they have some sort of other illness

that we have to treat first,

and activate the immune system for.

So, it can be a tug-of-war.

Just keep in mind these side effects,

in the back of your mind.

So we come here on the O.A.
side, pain control, health.

Remember the demographics here are people

that tend to be elderly, overuse joints,

or they're carrying extra weight.

So lifestyle here is gonna be number one.

Number one as in the first thing to try

and the last thing to stop trying.

So we have diet, exercise,

whatever it takes for weight loss.

Being at a healthy weight
really decreases the strain

on our joints.

Weight loss.

And of course, if you're not
overweight to begin with,

then a lot of the O.A. probably couldn't

be attributed to that.

So weight loss in the case

of extra weight
exacerbating the arthritis.

There's physical therapy,
people to teach you

how to use your joints correctly,

so as to not damage them more.

But also building up muscles,

because a lot of times
when your joints hurt,

people stop using that joint or that limb,

and their muscle can go
into what we call atrophy,

or they shrink, and they
become not as effective.

So P.T., physical therapy,
and getting muscle training,

using the joint correctly,
could actually decrease a strain

on that joint when the muscle is strong.

So physical therapy can
stop people from spiraling

into this bad cycle of my joints hurt,

so I don't use my muscles,
so my joints hurt more,

because my muscles are not working.

Now on this side, we also
have the N.S.A.I.D.'s.

And actually because this is people

who might need to take it for
a long time, acetaminophen,

what we think of as Tylenol,

is also used, and can be used,

first-line for less of your symptoms.

Because this is bad for, for
example, G.I. side effects.

Side effects.

The acetaminophen does not
hurt the gut in the same way.

So these are both over-the-counter
and they treat pain.

But since we know over here

that they're also anti-inflammatory,

there's gonna be local inflammation

in the joint from the osteoarthritis,

so this is also a good way

of just keeping the area under control.

Since the pain is so localized here,

usually to the specific joint,

and it's not global, like
in rheumatoid arthritis,

we can do injections into the joint.

It can be a very good release of pain,

and these can be steroid injections.

So if your shoulder hurts,
they can inject the steroid

right into the shoulder.

And steroids, we know from here,

also decrease inflammation in the area.

They can also inject analgesics.

Analgesics.

So deliver the pain
control right to the area.

I just realized my color
coding is off here.

I should have used white for these,

so let me put some white dashes,

but you get the idea here.

And then, of course, at the end,

we can also think about surgery.

I'm gonna put it kinda in the middle,

because technically you can
do surgery for both sides.

We don't want to get to this point.

But sometimes when the
damage is too great,

we may need to replace the joint.

It involves some risk
and a lot of recovery,

so we don't wanna do this for first-line.

In fact, they don't wanna
do this in young people,

because the joint they put in
will fail, too, after a while.

So if you put it in someone who is 30,

they're gonna have to keep
getting joint replacements.

So try to prolong their function

and decrease their symptoms,

so that they don't get to surgery.

Or if they do, it will be later on.