Beyond the Joints: Conditions Associated with Arthritis

Although arthritis literally means “joint inflammation,” anyone who has one of the many forms of arthritis and related conditions knows the condition often extends far beyond bones and cartilage.

Following are some of the more common associated conditions and the treatment for them.

Sjögren’s syndrome

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system attacks its moisture-producing glands. It often occurs along with other autoimmune diseases, such as RA, scleroderma or lupus. For most people, the predominant symptoms are dry eyes and/or mouth. Both prescription and OTC drugs can help.

Two oral medications, pilocarpine hydrochloride (Salagen Tablets) and cevimeline hydrochloride (Evoxac), are approved for treating dry mouth associated with Sjögren’s. Because both drugs can cause excessive sweating, it’s important to drink plenty of water to avoid dehydration while using them.

For dry mouth that is less severe, artificial saliva products in the form of rinses or sprays can help. (Sample OTC brands include: MouthKote, Optimoist, Oralbalance, Salivant and Salivart.)

Although they are not approved for such, both Salagen and Evoxac may also help ease dry eyes associated with Sjögren’s syndrome. Artificial tear products, including Bion Tears, Celluvisc, GenTeal, HypoTears, Refresh and Tears Naturale, can also ease dry and gritty-feeling eyes.

Psoriasis

For people with psoriatic arthritis, scaly patches of skin (known as psoriatic plaques) accompany joint involvement.

For many people with psoriatic arthritis, both the joint and skin problems are managed with DMARDs like sulfasalazine (Azulfidine), injected gold and methotrexate (Rheumatrex, Trexall). Strong immune-suppressing drugs such as azathioprine (Imuran) and cyclosporine (Sandimmune, Neoral) or the biologic agents etanercept (Enbrel) and infliximab (Remicade).

If these treatments alone don’t control the skin problems, doctors may prescribe some of the following additional medications: steroid ointments and creams; topical coal tar preparations, including Tegrin and T-Gel; calcipotriene (Dovonex), a synthetic form of vitamin D3 applied topically; tazarotene (Tazorac), a prescription vitamin A derivative applied topically; etretinate (Tegison) and Isotretinoin (Accutane), vitamin A derivatives that are taken orally; anthralin (Drithocreme, Dritho-Scalp, Micanol), a prescription topical medication; and salicylic acid, an over-the-counter topical preparation.

A systemic drug called psoralen, along with exposure to ultraviolet A light, may treat more severe skin involvement.

Irritable bowel syndrome

By some estimates, as many as 70 percent of people with fibromyalgia have symptoms of irritable bowel syndrome (IBS) – abdominal pain and bloating along with constipation or diarrhea or alternating bouts of the two.

Tegaserod maleate (Zelnorm) recently became the only prescription drug approved by the FDA to treat the multiple symptoms of abdominal pain, bloating and constipation associated with IBS. Earlier, a drug called alosetron hydrochloride (Lotronex) was approved for treating diarrhea-predominant IBS.

Although Zelnorm and Lotronex are the only drugs approved for IBS, doctors may prescribe others. Among the most commonly prescribed are those from a class called anticholinergic (antispasmotic) drugs, which can reduce the overactivity of the intestine in people prone to IBS-related diarrhea. These drugs include dicyclomine (Bentyl, Spasmoban) and hyoscyamine ( Anaspaz, A-Spas S/L, Cytospaz, Donnamar, ED-Spaz, Gastrosed, Levbin, Levsin and Symax SL).

Antiphospholipid antibody syndrome

People with this autoimmune condition, often seen in conjunction with lupus, develop antibodies to the lipid (fatty) membrane of cells and are at risk for potentially dangerous blood clots. To prevent clots in people with this condition, doctors may prescribe one of several medications. In some people, low-dose aspirin reduces clotting risk sufficiently; others require more potent anticoagulant medications, such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).

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