Osteoarthritis

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Osteoarthritis Treatment

OVERVIEW:
The goals of treatment are to relieve pain, maintain or improve joint mobility, increase the strength of the joints, and minimize the disabling affects of the disease. The specific treatment depends upon the affected joint(s).

MEDICATIONS:
Medications used to treat osteoarthritis include a variety of nonsteroidal, anti-inflammatory drugs (NSAIDs). A two-week trial period is necessary to evaluate the benefit of a particular medication.

A new class of drugs (called COX 2 inhibitors) that have the anti-inflammatory effects of NSAIDs, but don't upset most people's stomachs are now used commonly. Celebrex, Vioxx, and Bextra are the currently available forms of this type of drug.

Steroids, which are injected directly into the joint, may also be used to reduce inflammation and pain.

Many people are finding benefit from over-the-counter remedies like glucosamine and chondroitin sulfate. There is some evidence in the medical literature that these supplements are helpful in controlling pain, although they do not appear to grow new cartilage.

• Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee and lead to temporary relief of pain for up to six months.

LIFESTYLE CHANGES:
Exercises are important to maintain joint and overall mobility. Physical therapists and occupational therapists can prescribe an appropriate home exercise treatment. Exercises done in water are often effective for increasing mobility.

Heat and cold treatments, protection of the joints, the use of self-help devices and rest are all recommended.

Good nutrition and careful weight control are important. Weight loss for overweight individuals will decrease the mechanical strain placed on the joints of the lower extremities.

THERAPY:
Physical therapy can be useful to improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis, each of which some patients find helpful. If therapy is not helping after 3-6 weeks, then it will likely not be of benefit.

SURGERY:
Surgical treatment to replace or repair damaged joints is indicated in severe, debilitating disease. Surgical options include:

• arthroplasty (total or partial replacement of the deteriorated joint with an artificial joint -- see knee arthroplasty, hip arthroplasty)
• arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
• osteotomy (change in the alignment of a bone to relieve stress on the bone or joint)
• arthrodesis (surgical fusion of bones, usually in the spine)