Have you been diagnosed with osteoarthritis? Have a look at your treatment options:
Osteoarthritis primarily affects the cartilage lining of the joints and the bones associated with the joints. Find out how it's treated.
Patient education is particularly important. In spite of pain, it is important to keep active. Exercise maintains range of motion, and develops the stress-absorbing muscles and tendons. Daily stretching exercises are very important. Partial or complete immobilisation of a joint for relatively short periods can accelerate osteoarthritis and worsen the clinical outcome.
Interestingly, progression of osteoarthritis of the hips and knees can be retarded by a well-planned exercise regime.
These are divided into symptomatic and disease modifying therapies. Symptomatic therapies include analgesics – painkillers; such as paracetamol, and paracetamol/codeine preparations or even stronger opiate type drugs, such as tramadol which treat pain alone. These drugs are very safe and may provide sufficient relief. Anti-inflammatories, NSAIDs, which treat inflammation and pain, include aspirin and other non-steroidal anti-inflammatory drugs. These are potentially hazardous to the stomach. Newer safer drugs called COXIBs are available, including Celebrex. These are less damaging to the lining of the stomach. Cardiovascular safety of these drugs is, however, still under scrutiny and they should be used with caution in those with heart disease, high blood pressure, or strokes.
Oral cortisone is not helpful in osteoarthritis, but cortisone injections into the joint are useful when there are signs of inflammation. However, these are usually only needed occasionally.
There is some evidence that glucosamine sulphate has a role to play in pain and stiffness management. It is made from shrimp and crab shells and can therefore not be used if the patient has a seafood allergy. Chondroitin sulphate (made from bovine cartilage) may add some small further benefit.
Drugs such as antimalarials, tetracyclines and metalloproteinase inhibitors are in trials for disease modification in osteoarthritis.
Hyaluronan injections are lubricants similar to joint fluid, made from rooster comb. These are expensive and are not proven to work. They are therefore not currently recommended for widespread use.
Surgery for damaged joints is very successful, with hip and knee replacements now commonplace operations. Hip replacement restores mobility and relieves pain in at least 95 percent of cases. Hip replacements last for at least ten to 15 years.
Other joints, such as the small joints of the fingers and even the shoulder joint are also being replaced with increasing success. A particularly successful operation can be performed for advanced osteoarthritis at the base of the thumb. An expert hand surgeon is able to craft an alternative joint surface using the patient's own tissues.
Indications for surgery are joint pain non-responsive to medical therapy, or function impairment. Age alone is not a contra-indication to surgery, but joint replacement is usually deferred in younger patients where possible.
With the correct approach of remaining active and keeping a check on weight, osteoarthritis need not become a disabling condition. However, the damage to the joints usually starts before symptoms arise, making it difficult to act early.
When to see your doctor
Consult your doctor if:
• A joint is becoming increasingly painful and swollen.
• You experience sudden extreme pain or immobility in a joint.
• You have experienced pain and swelling in your knee(s) and it now starts to give way on movement, particularly when going up and down stairs.
• You know that you have osteoarthritis of your weight-bearing joints, are overweight and would like some advice on weight loss and exercise.
• When you are no longer able to cope and suspect you need replacement surgery.