Editing Arthritis (section)

== Treatment ==
There is no known cure for arthritis and rheumatic diseases. Treatment options vary depending on the type of arthritis and include [[physical therapy]], exercise and diet, [[Brace (orthopaedic)|orthopedic bracing]], and oral and topical medications.<ref name=niams/><ref>{{cite web|title=Knee braces for osteoarthritis - Mayo Clinic|url=https://www.mayoclinic.org/tests-procedures/knee-braces/about/pac-20384791|access-date=31 March 2021|website=www.mayoclinic.org}}</ref> [[Joint replacement surgery]] may be required to repair damage, restore function, or relieve pain.<ref name=niams/>

=== Physical therapy ===
In general, studies have shown that physical exercise of the affected joint can noticeably improve long-term pain relief. Furthermore, exercise of the arthritic joint is encouraged to maintain the health of the particular joint and the overall body of the person.<ref>{{cite journal | vauthors = Ettinger WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, Craven T | display-authors = 6 | title = A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST) | journal = JAMA | volume = 277 | issue = 1 | pages = 25–31 | date = January 1997 | pmid = 8980206 | doi = 10.1001/jama.1997.03540250033028 }}</ref>

Individuals with arthritis can benefit from both physical and [[occupational therapy]]. In arthritis the joints become stiff and the range of movement can be limited. Physical therapy has been shown to significantly improve function, decrease pain, and delay the need for surgical intervention in advanced cases.<ref>{{cite journal | vauthors = Fransen M, Crosbie J, Edmonds J | title = Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial | journal = The Journal of Rheumatology | volume = 28 | issue = 1 | pages = 156–164 | date = January 2001 | pmid = 11196518 | url = http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=11196518 }}</ref> Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating osteoarthritis of the knee. Exercise often focuses on improving muscle strength, endurance and flexibility. In some cases, exercises may be designed to train balance. Occupational therapy can provide assistance with activities. Assistive technology is a tool used to aid a person's disability by reducing their physical barriers by improving the use of their damaged body part, typically after an amputation. Assistive technology devices can be customized to the patient or bought commercially.<ref>{{cite web|url=https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/assistive-technology.aspx|title=The Role of Occupational Therapy in Providing Assistive Technology Devices and Services|date=2018|website=www.aota.org|access-date=8 April 2018}}</ref>

=== Medications ===
There are several types of medications that are used for the treatment of arthritis. Treatment typically begins with medications that have the fewest side effects with further medications being added if insufficiently effective.<ref>{{cite web|url= http://www.arthritistoday.org/treatments/drug-guide/index.php|title=Arthritis Drugs|work=arthritistoday.org|access-date=5 July 2010| archive-url= https://web.archive.org/web/20100722013235/http://www.arthritistoday.org/treatments/drug-guide/index.php| archive-date= 22 July 2010 <!--DASHBot-->|url-status = live}}</ref>

Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment for [[osteoarthritis]] is [[acetaminophen]] (paracetamol) while for [[inflammatory arthritis]] it involves [[non-steroidal anti-inflammatory drug]]s (NSAIDs) like [[ibuprofen]]. [[Opioid]]s and NSAIDs may be less well tolerated.<ref>{{cite journal | vauthors = Reid MC, Shengelia R, Parker SJ | title = Pharmacologic management of osteoarthritis-related pain in older adults | journal = The American Journal of Nursing | volume = 112 | issue = 3 Suppl 1 | pages = S38–S43 | date = March 2012 | pmid = 22373746 | pmc = 3733545 | doi = 10.1097/01.NAJ.0000412650.02926.e3 }}</ref> However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of osteoarthritis, intra-articular [[corticosteroid]] injections may also be considered.<ref>{{Cite journal |last1=McAlindon |first1=Timothy E. |last2=LaValley |first2=Michael P. |last3=Harvey |first3=William F. |last4=Price |first4=Lori Lyn |last5=Driban |first5=Jeffrey B. |last6=Zhang |first6=Ming |last7=Ward |first7=Robert J. |date=2017-05-16 |title=Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial |journal=JAMA |language=en |volume=317 |issue=19 |pages=1967–1975 |doi=10.1001/jama.2017.5283 |issn=0098-7484 |pmc=5815012 |pmid=28510679}}</ref><ref>{{cite journal | vauthors = Taruc-Uy RL, Lynch SA | title = Diagnosis and treatment of osteoarthritis | journal = Primary Care | volume = 40 | issue = 4 | pages = 821–36, vii | date = December 2013 | pmid = 24209720 | doi = 10.1016/j.pop.2013.08.003 | s2cid = 43061687 }}</ref>

The drugs to treat [[rheumatoid arthritis]] (RA) range from [[corticosteroid]]s to [[monoclonal antibodies]] given [[Intravenous therapy|intravenously]]. Due to the [[autoimmune]] nature of RA, treatments may include not only pain medications and anti-inflammatory drugs, but also another category of drugs called [[disease-modifying antirheumatic drug]]s (DMARDs). csDMARDs, TNF biologics and tsDMARDs are specific kinds of DMARDs that are recommended for treatment.<ref>{{cite journal | vauthors = Donahue KE, Schulman ER, Gartlehner G, Jonas BL, Coker-Schwimmer E, Patel SV, Weber RP, Bann CM, Viswanathan M | display-authors = 6 | title = Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis | journal = Journal of General Internal Medicine | volume = 34 | issue = 10 | pages = 2232–2245 | date = October 2019 | pmid = 31388915 | pmc = 6816735 | doi = 10.1007/s11606-019-05230-0 }}</ref> Treatment with DMARDs is designed to slow down the progression of RA by initiating an [[adaptive immune system|adaptive immune response]], in part by CD4+ T helper (Th) cells, specifically Th17 cells.<ref name="pmid23383714">{{cite journal | vauthors = Kurebayashi Y, Nagai S, Ikejiri A, Koyasu S | title = Recent advances in understanding the molecular mechanisms of the development and function of Th17 cells | journal = Genes to Cells | volume = 18 | issue = 4 | pages = 247–265 | date = April 2013 | pmid = 23383714 | pmc = 3657121 | doi = 10.1111/gtc.12039 }}</ref> Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).<ref name="Chabaud_2000" />

=== Surgery ===
A number of [[Rheumasurgery|surgical]] interventions have been incorporated in the treatment of arthritis since the 1950s. The primary surgical treatment option of arthritis is joint replacement surgery known as arthroplasty.<ref name=":4">{{Cite journal |last1=Park |first1=Jisu |last2=Chang |first2=Moon Jong |last3=Kim |first3=Tae Woo |last4=D'Lima |first4=Darryl D. |last5=Kim |first5=Hyunkwon |last6=Han |first6=Hyuk-Soo |date=2024-12-04 |title=Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis |journal=Knee Surgery & Related Research |language=en |volume=36 |issue=1 |page=43 |doi=10.1186/s43019-024-00241-6 |doi-access=free |issn=2234-2451 |pmc=11616191 |pmid=39633483}}</ref> Common joints that are replaced due to arthritis include the shoulder, hip, and knee.<ref name=":4" /> [[Arthroscopic surgery]] for osteoarthritis of the knee provides no additional benefit  to patients when compared to optimized physical and medical therapy.<ref name="pmid18784099">{{cite journal | vauthors = Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D'Ascanio LM, Pope JE, Fowler PJ | display-authors = 6 | title = A randomized trial of arthroscopic surgery for osteoarthritis of the knee | journal = The New England Journal of Medicine | volume = 359 | issue = 11 | pages = 1097–1107 | date = September 2008 | pmid = 18784099 | doi = 10.1056/NEJMoa0708333 | doi-access = free }}</ref> Joint replacement surgery can last anywhere from 15 to 30 years depending on the patient.<ref>{{Cite journal |last1=Evans |first1=Jonathan T |last2=Walker |first2=Robert W |last3=Evans |first3=Jonathan P |last4=Blom |first4=Ashley W |last5=Sayers |first5=Adrian |last6=Whitehouse |first6=Michael R |date=February 2019 |title=How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up |journal=The Lancet |language=en |volume=393 |issue=10172 |pages=655–663 |doi=10.1016/S0140-6736(18)32531-5 |pmc=6381229 |pmid=30782341}}</ref> Following joint replacement surgery, patients can expect to get back to several physical activities including those such as swimming, tennis, and golf.<ref>{{Cite journal |last1=Liu |first1=Joseph N. |last2=Steinhaus |first2=Michael E. |last3=Garcia |first3=Grant H. |last4=Chang |first4=Brenda |last5=Fields |first5=Kara |last6=Dines |first6=David M. |last7=Warren |first7=Russell F. |last8=Gulotta |first8=Lawrence V. |date=January 2018 |title=Return to sport after shoulder arthroplasty: a systematic review and meta-analysis |journal=Knee Surgery, Sports Traumatology, Arthroscopy |language=en |volume=26 |issue=1 |pages=100–112 |doi=10.1007/s00167-017-4547-1 |pmid=28409200 |issn=0942-2056}}</ref>

=== Adaptive aids ===
People with hand arthritis can have trouble with simple [[activities of daily living]] tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. There are [[adaptive equipment|adaptive aids]] or [[Assistive technology|assistive devices]] (ADs) available to help with these tasks,<ref>{{cite web |last=Bloomquist |first=Michele |title=Arthritis-Friendly Tools |website=Everyday Health |date=5 February 2013 |url=https://www.everydayhealth.com/arthritis-pictures/10-terrific-arthritis-gadgets.aspx |archive-url=https://web.archive.org/web/20200530173038/https://www.everydayhealth.com/arthritis-pictures/10-terrific-arthritis-gadgets.aspx |archive-date=2020-05-30 |access-date=8 March 2019}}</ref> but they are generally more costly than conventional products with the same function. It is now possible to [[3-D print]] adaptive aids, which have been released as [[open source hardware]] to reduce patient costs.<ref>{{cite web |date=15 December 2018 |url=https://orthofeed.com/2018/12/15/3-d-printing-offers-helping-hand-to-people-with-arthritis/ |title=3-D Printing Offers Helping Hand to People with Arthritis |website=OrthoFeed |access-date=8 March 2019 |archive-date=15 November 2020 |archive-url=https://web.archive.org/web/20201115053144/https://orthofeed.com/2018/12/15/3-d-printing-offers-helping-hand-to-people-with-arthritis/ |url-status=dead}}</ref><ref>{{cite journal |vauthors=Gallup N, Bow JK, Pearce JM |title=Economic Potential for Distributed Manufacturing of Adaptive Aids for Arthritis Patients in the U.S |journal=Geriatrics |volume=3 |issue=4 |pages=89 |date=December 2018 |pmid=31011124 |pmc=6371113 |doi=10.3390/geriatrics3040089 |doi-access=free}}</ref> Adaptive aids can significantly help arthritis patients and the vast majority of those with arthritis need and use them.<ref>{{cite journal |vauthors=Yeung KT, Lin CH, Teng YL, Chen FF, Lou SZ, Chen CL |title=Use of and Self-Perceived Need for Assistive Devices in Individuals with Disabilities in Taiwan |journal=PLOS ONE |volume=11 |issue=3 |pages=e0152707 |date=29 March 2016 |pmid=27023276 |pmc=4811424 |doi=10.1371/journal.pone.0152707 |doi-access=free |bibcode=2016PLoSO..1152707Y}}</ref>

=== Alternative medicine ===
Further research is required to determine if [[transcutaneous electrical nerve stimulation]] (TENS) for knee osteoarthritis is effective for controlling pain.<ref>{{cite journal | vauthors = Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L, Reichenbach S, Jüni P | display-authors = 6 | title = Transcutaneous electrostimulation for osteoarthritis of the knee | journal = The Cochrane Database of Systematic Reviews | volume = 2009 | issue = 4 | pages = CD002823 | date = October 2009 | pmid = 19821296 | pmc = 7120411 | doi = 10.1002/14651858.CD002823.pub2 }}</ref>

[[Low level laser therapy]] may be considered for relief of pain and stiffness associated with arthritis.<ref>{{cite journal | vauthors = Brosseau L, Welch V, Wells G, Tugwell P, de Bie R, Gam A, Harman K, Shea B, Morin M | display-authors = 6 | title = Low level laser therapy for osteoarthritis and rheumatoid arthritis: a metaanalysis | journal = The Journal of Rheumatology | volume = 27 | issue = 8 | pages = 1961–1969 | date = August 2000 | pmid = 10955339 }}</ref> Evidence of benefit is tentative.<ref>{{cite journal | vauthors = Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, Morin M, Shea B, Tugwell P | display-authors = 6 | title = Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis | journal = The Cochrane Database of Systematic Reviews | volume = 2005 | issue = 4 | pages = CD002049 | date = October 2005 | pmid = 16235295 | pmc = 8406947 | doi = 10.1002/14651858.CD002049.pub2 }}</ref>

[[Pulsed electromagnetic field therapy]] (PEMFT) has tentative evidence supporting improved functioning but no evidence of improved pain in osteoarthritis.<ref>{{cite journal | vauthors = Vavken P, Arrich F, Schuhfried O, Dorotka R | title = Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials | journal = Journal of Rehabilitation Medicine | volume = 41 | issue = 6 | pages = 406–411 | date = May 2009 | pmid = 19479151 | doi = 10.2340/16501977-0374 | doi-access = free }}</ref> The FDA has not approved PEMFT for the treatment of arthritis. In Canada, PEMF devices are legally licensed by Health Canada for the treatment of pain associated with arthritic conditions.<ref>{{cite web|url=https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/licences/medical-devices-active-licence-listing.html|title=Medical Devices Active Licence Listing (MDALL) | work = Health Canada|date=16 July 2002 |access-date=28 March 2020}}</ref>