Treatment Approaches for Osteoarthritis

May 23, 2018

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Our last post took a closer look at what exactly osteoarthritis (OA) is and what causes it. This week, as we near the end of Arthritis Awareness Month, we’re going to take a closer look at some of the treatment options for OA. When treating OA, the main goal is to limit the inflammation, pain, and stiffness experienced in and around the affected joint in order to maximize your functional ability and quality of life.

Before beginning any kind of medical treatment, be sure to talk to a healthcare professional.

The Joint Replacement Therapists’ favorite approach to treating OA is through physical therapy. A physical therapist can perform a thorough evaluation of the affected joint, adjacent joints, and your body as a whole. The therapist will assess (among other things) your range of motion, flexibility, strength, endurance, function, and mobility. From this assessment, the therapist can provide a treatment plan that is individualized to your specific needs and goals.

Many people can receive significant relief of pain and other symptoms through an individualized therapy program and delay, or completely avoid, more invasive/risky treatment approaches. The Joint Replacement Therapists website has multiple resources regarding this topic, so be sure to check them out!

OA can also be managed effectively though positive lifestyle changes and activity modifications. Things such as eating healthy, regular exercise, and managing your weight can go a long way towards decreasing pain. Numerous studies have demonstrated the positive benefits of regular light-moderate aerobic activity and pain management. Some great activities include walking, biking, and swimming/water therapy. Many painful activities can also be modified to cause less stress on the affected joints. Some common modifications include improving technique/form, using assistive equipment, or taking adequate rest breaks.

One medical treatment approach to OA is pain medicine. Usually, common medications such as Acetaminophen (Tylenol) or NSAIDs (Aspirin, Ibuprofen, Indocin, Daypro, Naprosyn) can be taken to help manage pain. NSAIDs have an added benefit of limiting inflammation, too. Unfortunately, there is the possibility of adverse effects with taking these drugs, especially in large doses and/or for a long time. Side effects include irritation/ulceration of the digestive tract, kidney or liver dysfunction, and delays in tissue healing.

If oral medications don’t seem to provide relief, another option is corticosteroid injections into the joint. The purpose of these injections is to decrease inflammation, and in turn, decrease pain. The effects of steroid injections can last anywhere from a few weeks to 6 months. Because these steroids are catabolic (breakdown), long-term treatment may lead to destruction of the joint and surrounding tissues. For this reason, most doctors limit injections to about once every 3-4 months and recommend no more than about 4 shots in any one joint.

Another approach to treating OA is disease-modifying strategies. One example of this is viscosupplementation. This entails injecting Hyaluronan, a viscous fluid, into the joint through a series of 3 injections over 3 weeks. The proposed benefit of these injections is to restore the lubrication of the joint fluid, improve shock absorption, and decrease joint friction. This is a possible treatment option for individuals with moderate pain and/or looking to delay joint replacement surgery.
Studies looking at the efficacy of viscosupplementation have been inconclusive. Some studies show improvements in pain and function, while others demonstrate little to no improvement in pain and other symptoms following the injections. However, this treatment has very few adverse side-effects and may be worth trying if one is looking to delay surgery.

There is also the option of nutritional supplementation with chondroitin sulfate or glucosamine. The purpose of chondroitin sulfate is to improve the elasticity of the joint cartilage, while the purpose of glucosamine is to aid in joint cartilage formation and repair. Research regarding both of these supplements have been unable to demonstrate a positive response in regards to pain levels or specific changes to joint cartilage. Therefore, the benefit of these supplements for treating OA is debatable, at best.

If these treatment options are ineffective, there are surgical options. Besides total joint replacement surgery, other options include an osteotomy or hemiarthroplasty (partial joint replacement). An osteotomy is the removal of part of the bone around a joint to realign the joint and correct joint deformities. This surgery is used in younger patients trying to delay joint replacement surgery. It does not alleviate the OA within the joint.

A partial joint replacement involves removal and replacement of part of the joint, instead of the whole joint. This usually is performed when one part of the joint is more significantly affected from OA than other parts. It is less traumatic than a total joint replacement and allows faster recovery. To learn more about total joint replacement surgery, be sure to check out all the other great resources on our website!

It is important that anyone with OA work with their healthcare provider to create a comprehensive plan for treating and managing pain and other symptoms. Although the pain and stiffness from OA is due to the inflammation and destruction of the affected joint, pain is a complex and multifactorial phenomenon. It is important to learn about the science of pain and to learn effective ways to manage pain besides medication and surgery. When it comes to OA, each person is unique and there is no one correct treatment for everyone. The more informed and knowledgeable you can be, the easier it will be to create an individualized treatment approach that works for you.

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