Arthritis Treatment: Disease Modifying Anti-Rheumatic Drugs (DMARDS) and Their Side Effects

Rheumatoid arthritis is the most common inflammatory form of arthritis, affecting about two million Americans. It is a chronic, systemic, autoimmune disease for which there is no cure. However, there are medications available that can control it and put it into remission.

The key is early diagnosis and aggressive treatment.

This article will discuss some of the commonly used disease-modifying anti-rheumatic drugs (DMARDS.) Another article will discuss biologics.

Methotrexate is the “workhorse” of DMARDS. It acts by blocking an enzyme called dihydrofolate reductase, in effect, preventing the proliferation of inflammatory cells. It can be given orally, subcutaneously, and intravenously. Potential side effects include fatigue the day after taking the medication, nausea, hair loss, mouth ulcers, damage to the liver, drop in blood counts, particularly the white blood count, and lung damage which can occur acutely or develop chronically. Methotrexate is also a teratogen, and can cause significant birth defects.

Hydroxychloroquine (Plaquenil) is a drug that has been used to treat malaria but which has some modest effects in treating rheumatoid arthritis. It has an immunomodulatory effect which has not yet been clearly defined. Side effects include skin rash, particularly if the individual is out in the sun, muscle damage, gastrointestinal upset and diarrhea, and damage to the retina of the eyes.

Sulfasalazine (Azulfidine) is a sulfa drug that has anti-inflammatory effect. Once it is metabolized it breaks down into a number of components, one of which is 5-aminosalicylic acid. It is used in Europe much more than in the U.S. Side effects include gastrointestinal upset, drops in blood count, lung inflammation, inflammation of blood vessels, lupus, and a potentially life-threatening condition called Stevens-Johnson syndrome. This causes severe ulceration of the gastrointestinal and respiratory systems.

Leflunomide (Arava) is an oral drug that blocks the synthesis of pyrimidines, which are an active player in RA. Side effects include gastrointestinal upset, rash, liver damage, blood count drops, immune suppression, and birth defects.

Tetracycline is an antibiotic that also has the effect of blocking enzymes that stimulate inflammation. Tetracyclines also have an inhibitory effect on T-cells. Side effects include a photosensitive skin rash, teeth discoloration, lupus, inflammation of blood vessels, and liver damage.

Azathioprine (Imuran) is a potent immunosuppressive drug that blocks the production of purines. It can cause profound drops in blood count, liver toxicity, fever, and can be extremely toxic when combined with other medications such ass allopurinol.

By now your hair is starting to curl. Remember the flip side which is that rheumatoid arthritis itself is a severe disease which can shorten lifespan by ten to fifteen years and cause significant crippling, disability, and internal organ damage.

Metacam, Rimadyl and Previcox – Are These Drugs Safe to Use for Arthritis in Dogs?

Drug treatments for osteoarthritis have one of two primary objectives: Firstly, to make the patient more comfortable i.e. reduce the symptoms and signs of the condition. Secondly, and this is one of the major goals of osteoarthritis research, to slow or even reverse the osteoarthritis process that is causing progressive deterioration and loss of articular cartilage. Compounds that can slow the osteoarthritis process down are referred to as Disease (or structure) Modifying Drugs (DMOADs).

In clinical practice for both humans and dogs, the concept of disease modification is still rather theoretical with no treatment proven to have this effect. The main second line treatments in small animal veterinary practice are anti-inflammatory drugs.

Anti-inflammatory drugs

Most canine patients with some lameness associated with osteoarthritis will be best treated with anti-inflammatory drugs.When we talk about anti-inflammatories and OSTEOarthritis we are virtually always referring to the Nonsteroidal anti-inflammatories or the NSAIDs (pronounced as ‘en-sayds’).

The NSAIDs are a group of quite different drugs but they all work in a similar way. They all act to block the production of prostaglandins in body tissues. Prostaglandins are a family of chemicals produced by the body that promote inflammation, pain, and fever. As well as making the local blood capillaries more leaky (causing local swelling) they will make nerve fibres more sensitive and hence make us feel pain.

Anti-inflammatory drugs act to reduce prostaglandin production in the tissues and hence reduce inflammation and discomfort. Prostaglandins also have some beneficial and important protective effects in the body. These include regulating blood flow to the kidneys and maintaining a protective mucus barrier in the lining of the stomach. It is in blocking these actions as well as the ‘bad’ effects of prostaglandins that NSAIDs can cause some nasty and potentially fatal side effects.

NSAIDs act by blocking the action of an enzyme called cyclooxygenase (COX), which is vital to the production of prostaglandins in the tissues. There are at least two forms of this enzyme referred to as COX-1 and COX-2.  Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.

Since the prostaglandins protect the stomach and maintain a healthy blood flow to the kidneys, NSAIDs can cause stomach inflammation, gastrointestinal ulcers and cause kidney damage by reducing renal blood flow. The risk of serious kidney damage is magnified in dehydrated patients or patients in circulatory shock from blood loss.  COX-1 is particularly important in housekeeping functions and COX-2 is increased in the presence of inflammation. NSAIDs that preferentially block COX-2 seem to cause fewer gastrointestinal side effects.

COX-2 selective NSAIDs have become available for use in the dog. Three of the newer and most widely used agents, Metacam, Rimadyl and Previcox are licensed for use in a number of countries. They show preferential inhibition of COX-2 and show a lower incidence of side effects compared to drugs such as aspirin.

Generally anti-inflammatories alone seem to work well in the dog with arthritis. There are some drawbacks, mainly vomiting and diarrhoea, which can limit their usefulness in some patients and, lead to very serious complications in some. Their effects on reducing blood flow to the kidneys can be devastating in certain situations, typically those where there is some form of circulatory system problem such as shock or dehydration.

Play it Safe

Although NSAIDs have been associated with some serious side effects and adverse reactions, they provide safe, effective pain relief in the vast majority of patients. However, they are potentially very dangerous drugs and should be respected. I would advise the following rules are adhered to in order to minimize the chances of adverse reactions:

1.    Only use a veterinary licensed product provided/recommended by your veterinarian. Some human preparations have a much narrower safety profile in dogs than in people. Don’t do it!

2.    Stop using any NSAID immediately if your dog develops inappetance, vomiting and or diarrhoea. Consult your veterinary professional straightaway.

3.    Always consult your veterinarian before administering any other medications alongside NSAIDs.

4.    If at a veterinary visit you see a different person at the clinic, always remind them that your dog is on NSAIDs – It should be on your pet’s clinical notes but better to play it safe and mention it.

The NSAIDs are an important component of your pet’s arthritis treatment plan but they should be used with care and under the strict guidance of your vet. They are just one factor in successfully managing canine osteoarthritis.

Why a Detox Diet is Good For Your Gastrointestinal Tract?

Everyday, tons of toxins and unnecessary substances enters into our body particularly through the gastrointestinal tract. The gastrointestinal tract is derived from the mouth, teeth, esophagus, stomach, small intestine, and the large intestine.

Digestive organs like the salivary glands, pancreas, gall bladder, mucous glands, and liver are also parts of the gastrointestinal tract. In the book, “The New Detox Diet,” Elson M. Haas and Daniella Chace it was mentioned that the absorption of most nutrients happens in the small intestine. The colon assimilates water while the bile salts.

Minor disruptions in the gastrointestinal tract may cause abnormal assimilation of nutrients and increased barrier permeability. One of the best ways to do away with toxins and unnecessary substances in the body is through detox diet.

But what are these toxins and unnecessary substances that are harmful to your gastrointestinal tract?

The GI tract are adversely suffering from refined foods and sugar; excess fatty and rich foods; overeating and neglecting to chew more than once or twice per mouthful of food; drinking too much; food chemical substances, pesticides, and environmental toxins; persistent use of alcohol, caffeine, and nicotine; use of prescription, over-the-counter, and recreational drugs; lack of fiber and whole foods, specifically lacking fresh fruits, vegetables, whole grains, and legumes in the diet.

Detox diet assists in healing ulcerations and other tissue problems within your body. It also helps in maintaining the tone and shape of your small and large intestines. Detox diet maintains the PH balance and eliminates bad bacteria like candida and harmful yeasts. What many individuals don’t know is that even minor metabolism disruption like constipation if unguarded can result in a big threat in your health. Constipation also causes tension and discomfort and limited exercise. This is the reason why regular elimination is very crucial to health and maintaining the level of toxins in the body.

One way of detoxify is eating fiber rich foods and increasing water intakes. A special sort of herb called dandelion root is one of the popular medicinal plants that aids detoxification. It is a natural diuretic that increases pee production by propping up the excretion of salts and water from the kidney.

The Chinese uses this herb in treating digestive complaints and appendicitis. Dandelion now already comes in the kind of teas. However, extra precaution should be accepted at taking this herb as it could increase stomach acid and heartburn. Patients with gallbladder and gallstones are likewise prohibited to take this herb.

Apart from drinking teas and water, you may in addition try drinking fresh fruit juices to detoxify. But taking this detox diet is more effective if then of course you would cut down intakes of meat and fatty foods and other foods and chemical substances that adversely affects the function of your gastrointestinal tract. It is very important to plan your meal when in a detox diet. It can sometimes be a little tricky particularly because being in this diet makes you feel hungry and overdoing can cause you hyperacidity.

Another essential aspect to think about in undergoing a detox diet is your current weight and PH balance. It is better to consult a specialist before taking a detox diet.