Arthritis: treatment is personalized and multifactorial – 07/07/2023 – Equilíbrio

Erika de Souza Muniz, a 56-year-old retired judicial technician, spends her weeks with the help of injections of medication and cannabidiol, the oil extracted from Cannabis Sativa.

The strategy outlined with specialists fights “pains that make you cry”, in addition to the advance of rheumatoid arthritis, diagnosed in 2009. The main characteristic of the disease is inflammation of the joints.

“There were days when I couldn’t hold a fork, brush my teeth or do anything else that depended on my hands,” he says. “Today I am a different person”.

The injections he takes are sometimes with methotrexate, the medicine most used to control arthritis, sometimes with a biological medicine, produced from living organisms. “And cannabidiol takes my pain away.”

Retired environmental educator Carlos Eduardo Danilevicius Tenório, 50, resorts to corticoid injections and doses of analgesics and anti-inflammatories against osteoarthritis, or arthrosis, discovered at 36. The wear of the cartilage that lines the joints, typical of the condition, reaches its knees and hips.

He adapted the apartment where he lives and implanted a prosthesis in his left hip to reduce pain and facilitate movement. He waited for almost six years for the procedure in the public network. Now, he prepares to lay on the right side. “Arthrosis causes a pain that is throbbing, there, all the time. And it is a disease that incapacitates you a lot”, he says.

Coordinator of the Brazilian Association Overcoming Lupus, Rheumatic Diseases and Rare Diseases, he points out that one of the great demands of those who arrive at the institution is “the indication of a medication that will solve the problems”. “But the medications are individual. What works for one may not work for another, so we try to fight that.”

There is no survey on how many people have rheumatoid arthritis and arthrosis in Brazil, according to the Ministry of Health. Among rheumatic diseases, however, they are among the most frequent and, in terms of treatment, they walk in different rhythms.

“For rheumatoid arthritis we have approved numerous drugs with scientific proof of results and potential to improve symptoms. For arthrosis we have nothing specific with good results. We continue to only use drugs to reduce pain, reduce inflammation”, says rheumatologist Ana Paula Gomides, PhD in Medical Sciences and one of the authors of the first “real life study” in Brazil on the standards of treatment of patients with rheumatoid arthritis in the SUS (Sistema Único de Saúde).

Google searches on the diseases include “miracle ointment”, “best anti-inflammatory”, “collagen” and “home remedy”. “But there is no proof of treatments that resolve all cases and there is a risk of side effects”, warns Gomides. She stresses that all drugs approved in Brazil for rheumatoid arthritis are on the SUS.

The list includes disease-modifying drugs such as methotrexate, biological drugs, small-molecule Janus Kinase inhibitors – JAK inhibitors – and corticosteroids, which are the oldest, says Marco Antônio Araújo da Rocha Loures, president of SBR (Brazilian Society of Rheumatology).

In case of non-response with disease modifiers, it is possible to request the biological medication from the SUS at the Health Regions or at the Municipal Health Secretariats, he recommends. At the pharmacy, a box of this type of medicine can exceed R$ 10,000.

It is not possible to say which is the most effective and promising medication. Since there is no cure for rheumatoid arthritis or osteoarthritis, treatments are aimed at achieving remission or low disease activity. A therapeutic line indicated early by a rheumatologist can avoid surgeries and sequelae.

“All have excellent benefits and it will depend on the response of each patient. Some simply do not have a satisfactory result with a medication, due to individual characteristics or the disease itself. We have stages in which we change medications until we have a response. But there is no recipe cake, something like ‘everyone gets better with this'”, says Ana Paula Gomides.

Student Maria Luiza Borges, 18, has been seeking the best treatment since 2020, when she was diagnosed with juvenile idiopathic arthritis, as rheumatoid arthritis is called in younger populations. “Screaming pains” in the legs and heels began in childhood. A month ago, she started a new therapy. For her and her mother, Alessandra, it means “new hope”.

“Now I can walk, move around, dance and my doctor allowed me to go to the gym”, says the student. “I try to think ‘you have to have faith, right?’ To think that what I’m going through is because I deserve something much better in the future.”

The trails that the girl follows seek action against arthritis and lupus, discovered later. Treatments include psychological follow-up.

In the case of arthrosis, “unlike arthritis, there is no medicine that stabilizes the disease. Treatment is based on improving pain symptoms”, reiterates Gomides.

The drugs are mainly with analgesics and anti-inflammatories. Other drugs, such as antiarthritic drugs, are not available in the public health system and, according to Gomides, have not yet been proven to be effective.

Collagens, glucosamines and chondroitins, which advance in the market as capable of strengthening joints, for example, are not a consensus in the area. “They are medicines based on more natural substances that, in some cases, can help with the symptoms, but do not act effectively on the disease”, says Gomides.