TREATMENTS OF ARTHRITIS: NON-STEROIDAL AND STEROIDAL DRUGS

Non-steroidal drugs

Non-steroidal drugs, other than the salicylates, are used as anti-inflammatory, analgesic or anti-pyretic agents. Some have a combination of more than one of these properties. In general, the way in which these drugs work is not known, although it is possible to demonstrate the relative efficacy of one versus another by special trial procedures.

These drugs are usually marketed under trade names which derive from either their generic or chemical name. Considering them in general, it is fair to comment that most of the non-steroidal anti-inflammatory drugs take effect fairly quickly, usually within a few hours of consumption. It would also be fair to say that the effects are not long lasting, unless the drug is being taken regularly.

Side-effects of such preparations range from the usual gastric irritation and indigestion, with or without severe ulceration, to impaired vision, depression, skin rashes, loss of hair, impaired liver function, impaired kidney function, respiratory distress and changes in mental attitudes such as depersonalization. In rare cases bone marrow depression can also occur. One further aspect of many of these preparations is that they are not suitable for use with children.

Steroidal drugs

Another type of therapy is that using steroidal drugs. Usually steroidal drugs would be one of the last forms of therapy to Û tried on any patient. The dangerous effects of treatment with, and withdrawal from, these particular drugs are well known. It is also important that the clinician treating any patient with corticosteroid therapy is familiar with the various facto relating to that particular patient’s general condition before commencing. Use of corticosteroids in arthritic treatment usually produces a rapid and dramatic response. The person begins to feel much better in general and their arthritic condition shows a significant improvement. The mechanism of the anti-inflammatory and anti-rheumatic activity of the corticosteroids is not yet understood, but their effect is known to be palliative and not curative.

It would be reasonable to assume that, as a result of what has just been said about the beneficial effects of these preparations that they would be in widespread use. Unfortunately they possess some very unpleasant side-effects and therefore are only used as a last resort.

Probably the most hazardous effect of the steroids is that the anti-inflammatory effect is non-discriminating. This means that it can and does have an anti-inflammatory effect on the inflammation which is the body’s natural defense mechanism against some infectious agents. In addition to this, other side effects include a protein-wasting effect; a linear-growth impairing effect in children; a quite significant impairing o: wound healing capacity; a generalized osteoporosis effect (increasing porousness of the bones); ulcer development; development of syndromes such as rounding of the face; fattening around the waist; disorders of the eyes; menstrual disorders; depression and insomnia.

This is not a complete list, and of course, not all people who are treated with steroidal drugs will develop or experience these effects.

When these factors are considered together with the tact that, generally speaking, steroid therapy does not remain effective for long, and withdrawal from this therapy has unpleasant effects, it is easy to see why use of it is, generally made with great reluctance.

Before leaving the subject of drug therapy in the treatment 0f rheumatoid arthritis, gold therapy should receive at least brief mention.

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