Osteoarthritis Treatment
Self-Help Remedies, Medications, Surgery And Alternative Treatments

Osteoarthritis Treatments

Contents

• How Is Osteoarthritis Treated?
• Relief From Stressed Joints
• Pain Medications
• Injections
• Surgery
• Alternative Therapy
• What Does Not Work

There is no cure for osteoarthritis. Any medications and therapies prescribed are aimed at reducing symptoms so that the patient can continue performing daily tasks with minimum pain. Ultimately if a joint disintegrates to the point where it causes disability, surgery to replace the joint with an artificial one will be necessary. Below, we explain the different options for treating osteoarthritis.

Relief From Stressed Joints

Any treatment plan for osteoarthritis should include scheduled periods of rest. You need to learn to recognize your body's signals and know when it's time to stop or slow down. This will prevent joint pain caused by too much physical activity. Some people find it useful to wear special insoles in their footwear to reduce pain when walking or to use canes to take pressure off sore joints. Another common therapy is to use braces or splints to support joints or to keep them in place (immobile) during sleep or activity. Both devices should only be used for short periods of time, and be properly fitted by an occupational therapist (this therapist can also advice you on other suitable arthritis equipment). This is because braces that are rigid enough to stabilize a joint may also dangerously compress the flesh and cut off blood supply. And while splints may temporarily ease pain, they tend to cause muscle atrophy (the surrounding muscles weaken due to lack of use). In certain joints that don't require much movement, such as the thumb, this may not be a problem. But for other important joints like the knee, specific muscle strengthening exercises done under the supervision of a physical therapist are a better way at relieving pain and stiffness.

Pain Medications

Doctors prescribe medications to reduce or eliminate pain in patients with symptoms of osteoarthritis. Which drug is prescribed, depends on the intensity of the pain, your medical history (what other diseases you may have or may be at risk for) and the potential side effects. Antiinflammatory drugs (also called NSAIDs or nonsteroidal anti-inflammatory drugs), including aspirin and ibuprofen are effective pain relievers (although they do nothing to halt the progress of the disease). However excessive use of NSAIDs can lead to serious side effects, so it is probably better to use softer drugs like acetaminophen (Tylenol) for everyday moderate pain. Your doctor may prescribe several types of medications for your condition, including topical creams and sprays. For more information see, medications for treating osteoarthritis.

Cortisone Injections

Corticosteroids are powerful antiinflammatory steroids which your doctor injects directly into the affected joints for temporary pain relief. More commonly used for the treatment of rheumatoid arthritis, these injections can give instant relief. However, if taken over a long period of time then can cause osteoporosis, high blood pressure or diabetes. No more than 2 to 4 treatments a year are recommended.

Hyaluronic Acid Injections

Also known as viscosupplementation (or by brand names Suplasyn, Synvisc and Orthovisc), these medications are a new treatment approved only for osteoarthritis of the knee. Depending on which product your doctor uses, the treatment will be given in a series of 3 to 5 injections. Injections help restore the normal consistency of synovial fluid, a substance that breaks down as osteoarthritis progresses. In about 75 percent of cases, pain relief is achieved, mobility improved and the need for surgery delayed. There appear to be few side effects, although long term studies are not yet available.

Surgery

For advanced joint degeneration, orthopedic surgery may be required. Advances in orthopedic surgery have made total reconstruction of joints an effective alternative to medications. Techniques are still evolving but even with current methods, surgery can dramatically improve a patient's quality of life. Surgeries include:

Total joint replacement (arthroplasty)

Also called, arthroplasty, this surgery is the definitive treatment for osteoarthritis of the knee or hip (sometimes, but less commonly, the shoulder, ankle, elbow and toes). The destroyed joint is replaced with an artificial one (called a prosthesis). Over a million arthroplasty surgeries are performed in the United States every year, and the figures are rising. Newer prosthesis have a life of up to 20 years, which means for many older patients, it offers a permanent fix. Younger patients will require joint replacement surgery at a later stage.

Arthroscopic surgery
Less invasive than arthroplasty, this procedure involves inserting a small camera instrument called an arthroscope (about the size of a pencil) into the joint. This allows the surgeon to review the joint in detail and repair any damage. Typically the surgeon will:
• Remove or repair torn cartilage.
• Remove loose pieces of bone or cartilage.
• Trim torn pieces of cartilage.
• Reconstruct a torn ligament.
• Remove inflamed synovial tissue.
Recovery from this surgery is quicker than traditional open surgery and it is recommended that patients work with a physical therapist in the weeks after surgery to improve the final results.

Osteotomy
In younger people with certain types of knee deformities or with a damaged knee that could predispose them to osteoarthritis, an osteotomy may be recommended. The surgeon realigns the joint away from the damaged area, shifting the stress of weight bearing to the healthier section of the knee. Although an osteotomy can significantly improve symptoms for several years, many people will eventually require a total knee replacement. One major downside of the operation is that the patient requires the use of crutches for several months after.

For more specific details on symptoms, diagnosis and treatments:
Arthritis of the shoulder
Arthritis of the hand
Hip arthritis
Arthritis of the knee

Alternative Therapies

There are several non-drug therapies for relieving osteoarthritis pain. They include:

Hot and cold
Heat and cold, or a combination of both can reduce joint pain. Heat can be applied with warm towels, warm baths or hot packs to increase blood flow to the affected area. In some cases cold packs (or simply applying a bag of frozen vegetables wrapped in a towel) will reduce inflammation and numb the sore area. Sore joints before bedtime usually respond better to cold treatment. Ask your physical therapist for advice on which to use and when (find out for example if hot or cold therapy should be used after exercise).

Transcutaneous electrical nerve stimulation (TENS)
A small electronic device is used to send electric pulses to the nerve endings under the skin of the joint area. It seems to work by blocking pain messages to the brain. TENS was one of the first therapies in the electro-stimulation area. Now, a new broader category of electrical stimulation for relieving pain has been developed called Neuromuscular Electrical Stimulation (NMES). It works by stimulating muscles, so they become stronger and offer more support to the joints. Studies show that NMES is particularly effective on those with osteoarthritis of the knee. Those who use it may be able to postpone knee replacement surgery 4 years longer than those who do not. Digital NMES devices can be purchased for about $100 online but a prescription might be necessary.

Acupuncture
One large study by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reported that acupuncture relieves pain and improves function in knee osteoarthritis, and it serves as an effective complement to standard medical care. It may be equally effective in osteoarthritis of other joints. Unfortunately Medicare does not cover the cost of acupuncture but some private insurers do. Or, check out communityacupuncturenetwork.org, which is a non-profit based organization offering treatments for $15 to $40.

Supplements
Glucosamine sulphate:This is a combination of glucosamine and chondroitin sulphate, a substance traditionally used in veterinary medicine which may have a role in cartilage formation. Sold as a diet supplement (rather than a drug) anecdotal evidence suggests it may help reduce pain and increase mobility. It usually needs to be taken at a dose of 1500mg a day for 3 months before the effects can be felt. If you experience no improvement, stop taking it. Glucosamine should be avoided by diabetics, the very elderly and pregnant women. Chondroitin should be avoided by patients taking blood thinners like heparin. Furthermore, supplements are usually derived from crab shells, so avoid if you have a shellfish allergy.
High doses of vitamins: Osteoarthritis may progress more slowly in people who take high levels of vitamins C, D or E, or beta carotene. However further studies are still needed to conclude if vitamin therapy is a useful treatment.
Green tea: There is also some research to indicate that drinking green tea regularly may halt the progression of osteoarthritis.
For more: alternative treatments for arthritis.

What Does Not Work

Despite popular myth, there is no evidence that any of the following are useful in treating osteoarthritis:

1. Wearing of copper bracelets.
2. Following special diets.
3. Rubbing the industrial lubricant WD-40 on joints to lubricate them.

For more information, see the following:

• Living with osteoarthritis: 5 tips for looking after yourself.
• Osteoarthritis diagnosis: Tests and doctor appointment.
• What type of doctor treats osteoarthritis?

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