Types of Arthritis, and How They Guide Treatment
Why the cause of arthritis, degeneration versus autoimmune inflammation, determines whether NSAIDs, DMARDs, or biologics are the right approach.
What causes arthritis, and how does that influence treatment? Understanding the type is the first step to choosing the right therapy.
Osteoarthritis results from degeneration of cartilage and does not have systemic (whole-body) manifestations. Rheumatoid arthritis is a type of inflammatory arthritis with a genetic basis (HLA-DR4 genes) and autoantibodies (rheumatoid factor and anti-CCP) that can attack the joints as well as the eyes, skin, lungs, heart, nerves, blood vessels, and GI tract.
Psoriatic arthritis is associated with the inflammatory skin disorder psoriasis. Spondyloarthropathies are a group of arthritides seen in younger patients that can affect the spine and peripheral joints such as the hips, knees, and sacroiliac joints, often associated with the HLA-B27 gene.
When the cause is RA or PsA, treatment for hand arthritis may start with an NSAID or acetaminophen for pain relief. Beyond that, disease-modifying agents (DMARDs) like methotrexate and sulfasalazine, and biologics (TNF inhibitors, IL-6 inhibitors, JAK inhibitors) given by injection or infusion, target specific inflammatory chemicals called cytokines.
These medications are effective because they interrupt the cytokines that trigger and sustain the inflammation cascade, reducing joint swelling, pain, and stiffness while improving fatigue.
Dr. Maggie Cadet, MD