Treatment of osteoarthritis has two goals as its main objectives.
- decrease the pain and discomfort you may be experiencing and increase function
- decrease any disability
Methods of treating osteoarthritis vary according to each individual’s needs. In some cases non-pharmacological treatment may be started, with the patient educated in physical and occupational therapy programs to achieve the goals of decreasing pain and disability.
More involved cases of osteoarthritis may require pharmacological management with regular monitoring by your physician as well as physical and occupational therapy programs. In several cases, especially those involving the weight bearing joints, surgery may become necessary to decrease the pain and disability.
Treatment methods for patients include:
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Joint Management Progams
Lifestyle changes – education of patients and family members and weight loss can be effective.
Physical therapy – with emphasis on maintaining the patients joint motion, muscle strength, and ambulation.
Occupational therapy – to assist patients in maintaining independence and self reliance in performing activities of daily living.Many times a physical and occupational therapist will work together with the patient to not only supply the necessary instructions needed, but also the equipment and ideas to simplify tasks for patients.
Pharmacological (Drug Treatment)
Because osteoarthritis is a degenerative process and not an inflammatory one, pharmacological treatment can be managed in several ways.
Acetaminophen (Tylenol) – initially, this may be the drug of choice and clearly has a lower incidence of side effects than other agents which may be used.
Aspirin or NSAIDS (non-steroidal anti-inflammatory medications) are frequently used if patients do not respond to Tylenol. Gastrointestinal complications are more likely to occur in this group, with this risk being increased threefold in patients treated with these medications.
Pain medications such as Darvocet, Codeine, or in some cases other narcotic agents, can be helpful in short term management of acute flares.
Intra-articular injections – not usually recommended in early treatment, joint injections may be helpful to elderly patients or patients in which other medications are ineffective or unsafe to use.
There are many over-the-counter nutritional supplements that claim they can improve the symptoms of arthritis. These supplements should be discussed with your physician. Many of these supplements have not been scientifically studied or proven to be of benefit to the patient.
Recently, much interest has been generated in the use of glucosamine, chondroitin sulfate, or the combination. Laboratory and clinical studies have suggested that these materials, which are the building blocks for cartilage, may have a positive effect on cartilage and arthritis.
One nutritional supplement, Cosamin DS, is a patented combination of these two materials. In a small clinical study, this combination was shown to improve the pain and function in patients with mild to moderate osteoarthritis. We are currently involved in a larger study to evaluate this further.
Electrical Stimulation Therapy
Several studies that we have participated in have evaluated the application of electrical stimulation to the treatment of patients with osteoarthritis and rheumatoid arthritis of the knee and hand.
The latest study indicated that treatment with Bionicare® Electrostimulation was effective in delaying the need for prosthetic reconstruction in patients with severe OA of the knee. As this treatment becomes available, it may be a useful method for certain types of arthritis.
Various surgeries may be beneficial to patients with osteoarthritis, especially when the joints of the lower extremities, or weight bearing joints, are involved.
Surgeries which can be performed are:
- Arthroscopic debridement
- Cartilage resurfacing
- Hemi arthroplasty
- Osteotomy of the hip or knee
- Total hip replacement
- Total knee replacement
3. Altman, R., Alarcon, G., Appelrouth, D., et al., The American College of Rheumatology Criteria for the Classification and Reporting of Osteoarthritis of the Hip, Arthritis Rheum., 34 (5): 505-514, 1991.
4. Altman, R., Asch, E., Block, D., et al., Development of Criteria for the Classification of Osteoarthritis of the Knee, Arthritis Rheum., 29 (8): 1039-10.