|
Return to Referring Physicians Main Page
Arthritis affects more than 70 million people in the United States, making it the most prevalent musculoskeletal condition. The precise cause of why we develop arthritis is not clearly defined. Precipitating factors include a genetically inherited predisposition, injury, surgical removal of cartilage, muscle weakness and joint misalignment, among others.
Treatment of osteoarthritis (OA) begins with identifying its preventable and treatable causes. The goal of OA therapy is to relieve pain and improve joint function. Treatment typically begins with non-operative measures.
Oral Medications
The most commonly used medications used to treat OA include the non-steroidal anti-inflammatory drugs (NSAID's) such as ibuprofen. NSAID's work by decreasing the inflammation associated with OA. They are effective at relieving the pain and swelling associated with OA in most patients. Unfortunately, many of these medications may result in gastric problems with chronic use.
Side effects of traditional NSAID's led to the development of a newer generation of NSAID's (Celebrex). This medication has similar anti-inflammatory properties, but does not have the gastro-intestinal side effects. As a result, this newer class of medication revolutionized the medical treatment of OA because the medication can be used on a long term basis. However, some of these newer arthritis drugs have been pulled off of the shelf due to recent reports of cardiac side effects.
Physical Therapy
Physical therapy (PT) is an important adjunct in the treatment of OA. Often times due to the pain associated with activity, muscles begin to weaken and support for the joint is decreased. Physical therapy can maintain joint range of motion and strength. More recently, aquatic therapy has shown to be of some benefit as well.
Weight Loss
For those patients who are overweight, weight loss through proper diet and exercise has proven to be the most important modifiable risk factor in the prevention and treatment of joint pain due to osteoarthritis.
Orthotics
Ambulatory assist devices such as a cane or walker may help offset some of the weight bearing load on a joint. OA bracing has been shown to improve the symptoms in those patients who have OA and a joint misalignment problem (bow-legged) by transferring the joint forces to a more normal position. Shoe orthotics can produce a similar effect.
Nutrisupplementation (Glucosamine/Chondroitin Sulfate)
Over-the-counter dietary supplements for the articular cartilage derived from bovine trachea and shellfish are also available. These supplements provide the necessary building blocks of articular cartilage that we are not able to consume in our regular diet. The jury is still out regarding the effectiveness of these supplements. A good percentage of people respond positively while others have no response.
Injections
Joint injections are the last line of non-operative treatment of OA. Two types of injections are available - cortisone and viscosupplementation. Cortisone injections provide temporary relief of OA pain and swelling through its anti-inflammatory effects. Cortisone injections may be effective, but in most cases, may only be given three to four times per year.
Joint lubricant injections (viscosupplementation) not only have anti-inflammatory properties, but they also stimulate the joint production of hyaluronic acid, an important constituent of articular cartilage. Treatment requires a series of three to five injections which can be given every six months if needed. These injections are FDA approved for the knee only.
Current Recommendations
For patients with a diagnosis of OA, we begin by prescribing a short course of an NSAID. Ice may also be of benefit for the acute flare-up. Avoidance of high impact activity which may aggravate the affected joint is also recommended. We recommend that patients work with a therapist to establish a home program for maintaining joint strength and flexibility. We do recommend treatment with oral glucosamine/ chondroitin for overall cartilage health.
For patients who fail the above treatments, we often use a cortisone injection and then progress to off-loading the affected joint with either an adjusted, over the counter shoe insert or a custom biomechanical device (orthotic). . Surgery may be recommended for patients who do not respond to non-operative treatment measures.
Return to Referring Physicians Main Page
Our Services | Referring Physicians | About Us | Frequently Asked Questions | Blog | Articles
Surgical Animations | Links | News & Press | Photo Gallery
Contact Us | Home | Legal Notice | Privacy Statement | Site Map
Copyright © Buffalo Medical Group P.C. / Podiatry Affiliates
Website Design, Maintenance and Hosting by Catalyst Marketing / Worry Free Websites |
