The arthritis arsenal: corticosteroids, antidepressants and topical formulas

Even if exercise and good eating habits are mainstays of your treatment, you'll likely need extra control of pain and inflammation with medications your doctor can recommend. But your treatment options have never been better.

Even if exercise and good eating habits are mainstays of your treatment, you'll likely need extra control of pain and inflammation with medications your doctor can recommend. But your treatment options have never been better.

• Corticosteroids are synthetic hormones that can help subdue inflammation and quell RA-related pain.
• Hailed as a breakthrough when introduced in the 1950s, they've since become notorious for side effects such as cataracts, gastric bleeding, facial swelling and weight gain. But used carefully, steroids can be potent weapons.
• They're particularly effective in low (read: safer) oral doses.
• And when injected directly into joints (up to three or four times a year without harming the joint), they can control inflammation for weeks or months without causing side effects throughout the body.

• For fibromyalgia patients, tricyclics and selective serotonin reuptake inhibitors (SSRIs) are given mainly to improve sleep and relax muscles rather than to relieve depression.
• Both types of drugs work well to mitigate the fatigue and non-rejuvenating sleep experienced by people with FM.
• In general, drugs that improve sleep have proven to be the most useful medications for treating fibromyalgia.

Anyone who's ever wished they could rub a little aspirin right onto a painful joint appreciates a good topical drug. Also called rubefacients, these drugs generally offer fast, noticeable pain relief, without the sometimes grim side effects associated with oral non-steroidal anti-inflammatory drugs (NSAIDs). The relief offered by a topical rub is only temporary, however.

Salicylates.

• Several well-known topical formulas contain salicylate to reduce pain and swelling. The salicylate family includes acetylsalicylic acid (ASA), the active ingredient in aspirin.
• Salicylates work on arthritis pain as well as tendonitis, sprains and other injuries by penetrating the skin a short way, and by being absorbed into the bloodstream.
• Some create a warming sensation, which will help distract the user from his or her pain.

Capsaicin.

• The second class of topical pain relief products is those that contain capsaicin, which is the chemical responsible for the heat of cayenne and chilli peppers.
• There is a widespread belief that capsaicin rubs work better than salicylates, simply because they're better understood: Capsaicin products rob sensory neurons of substance P, which is the chemical that transmits pain to the brain.
• To be effective, capsaicin rubs must be applied several times a day, with a noticeable improvement in pain reduction coming after several days of use.