OSTEOARTHRITIS - Conservative Management

By Josh  Butler, MMS, PA-C

Osteoarthritis, OA, is currently affecting upwards of 80% of individuals over the age of 55 and is the leading cause of disability in the elderly. While not every patient who has OA experiences symptoms, close to 20% will. These patients suffer from significant pain, decreased motion in their joints and limitations in their daily lives.

OA is the most common form of arthritis and often affects the knee or hip. The cartilage in the joint which provides protection of the bones and allows pain-free movement and cushioning, begins to be broken down naturally by aging. As this cartilage deteriorates further over time, patients will experience pain with motion of the joint and possibly even pain at rest. Arthritic knee pain is a common problem for many of our patients, and it’s important for our patients to be informed as to the many treatment options that exist. Since OA is a progressive and irreversible disease, the only true “cure” is a total joint replacement. However, there are non-surgical options which may be attempted first that might alleviate your pain and allow you to resume normal daily activities without having to undergo surgery.

Initial treatment may consist of rest, anti-inflammatories such as Advil or Aleve, and possibly a course of physical therapy. Weight loss and other lifestyle changes can also assist in reducing pain and disability. If these simple and non-invasive treatments don’t provide a significant relief of symptoms, injections can be considered.

The first type of injection used is a steroid, such as Cortisone, that is paired with numbing medicine that is injected into the knee joint. Pain relief is initially provided by the numbing medication and then subsequently by the steroid which assists with reducing inflammation. The pain relief that patients experience is difficult to predict. Some individuals will experience pain relief for upwards of six months while others may only have a few days of pain reduction. Injections for the hip are not as common and are often done under x-ray guidance due to the difficulty of assuring appropriate placement of the medicine within the joint.

The second type of injection available is referred to as viscosupplementation and is administered as weekly injections into the knee joint. The supplement is a protein rich lubricant derived from hyaluronic acid, which is similar to that which is already in our joints. The lubricant coats your joint, allowing less painful movement similar to the way oil lubricates your car engine. Synvisc and Hyalgan are two of the most commonly used brands and are injected weekly for three to five weeks, respectively. This injection of replacement lubricant will often provide patients with excellent results that have been proven to last up to six months for roughly 60% of patients. There is little to no risk of repeating a series of injections if significant pain relief is achieved after the original series.

Glucosamine Chondroitin sulfate is an over-the-counter supplement that may aid in the treatment of arthritis as well. Early clinical studies have shown it to alter the progression of OA and potentially even rebuilt the cartilage that has been broken down over time. Glucosamine is an amino sugar found naturally in the body that assists with cartilage formation and protection. Chondroitin is a protein that gives our cartilage elasticity.  When combined in an oral pill, they have been proven to be a long-term effective treatment of OA similar to that of anti-inflammatory medications as well as acting to slow cartilage damage. The supplement is recommended to be used as an addition to other treatments and does not provide immediate results. The full effect may not be felt until months after taking the supplement. Studies suggest taking 1,500 mg of Glucosamine and 1,200 mg of Chondroitin daily for the best effects.

Ultimately, there is no true cure for OA other than a total joint replacement. Despite the great results total joint replacements provide, many patients may not be physically or mentally ready for a major surgical procedure of this nature. Talk to your OAL physician regarding possible non-surgical options that may work for you.