What Are Some Medical Treatments For Osteoarthritis?

Osteoarthritis is the most common type of arthritis. Although it cannot be cured, its symptoms—such as pain, stiffness, and swelling—can usually be managed effectively. Doctors try to achieve this goal with the least amount of medication possible and with the safest medications possible.

Regular exercise is very helpful in relieving symptoms and preventing disease progression; maintaining a normal body weight is also important in this regard. Aerobic exercise and exercises to strengthen the quadriceps (a large muscle in the front of the thigh) are particularly helpful for treating OA of the knee or hip.

Regular exercise is very helpful in relieving symptoms and preventing disease progression; maintaining a normal body weight is also important.

Likewise, walking aids such as canes are helpful in the management of hip and knee OA. These devices decrease pain by reducing the weight placed on an arthritic hip or knee. Their use allows for increased physical activity.

If you use a cane, you should hold it in the hand opposite the knee or hip that is hurting. For example, if your right knee hurts, hold the cane in your left hand. Some people associate the use of a cane with age and disability. Those people may choose to use a cane selectively—for example, when they know they will be walking some distance, as in a fairground or shopping mall. Using the cane this way can alleviate flare ups of discomfort both during and after the activity.

Taping of the patella can be helpful for relieving some types of knee pain. A wide variety of different knee braces can also be very helpful in such cases. A physical therapist can assist you in deciding whether any of these treatments are right for you. Many of these treatments have been discussed elsewhere in this book as well.

If medication is necessary, then the safest drugs should be selected first. Many people will do well taking acetaminophen (brand name: Tylenol). Although this drug is not an anti-inflammatory medication, for many people it is an effective treatment for pain. Unlike many prescription medications, acetaminophen is inexpensive, readily available, and relatively safe. The side effects most commonly associated with acetaminophen include nausea, constipation, and occasionally drowsiness. The most worrisome side effect is liver toxicity, though this problem is exceedingly rare when acetaminophen is taken as directed.

If acetaminophen doesn't work or doesn't work well enough, a nonsteroidal anti-inflammatory drug (NSAID) can be tried. These medications are available both in over-the-counter formulations and in higher doses by prescription from your doctor. The side effects most commonly encountered with this class of medication are upset stomach and ulcer complications. The risk of stomach ulcers is greatest in those individuals who have acid reflux disease, use corticosteroids, smoke tobacco, or drink alcohol. Those persons who are at highest risk for ulcer disease may need to take additional medications such as cimetidine (Tagamet) or omeprazole (Prilosec) to help protect their stomachs against these side effects. Misoprostol (Cytotec) can also be used to protect the stomach, but it produces upset stomach symptoms as well, so it is not used frequently for this purpose. Unfortunately, the need to protect the stomach increases the number of pills that must be taken—and hence the cost of treatment.

Taking NSAIDs is also associated with a risk of damage to your kidneys. This risk is greatest in people who are older than 65, individuals with hypertension or congestive heart failure, or those taking diuretics or angiotensin-converting enzyme (ACE) inhibitors. Patients who are on anticoagulation therapy, such as those taking warfarin (Coumadin) or heparin, should also use NSAIDs with caution.

Members of a newer type of NSAID class, called COX-2 inhibitors (such as Celebrex), have received a lot of attention recently. These medications have a little less risk of serious stomach complications such as ulcers, but they are much more expensive than the older NSAIDs, and their safety advantage for the stomach is cancelled out if you take even a small dose of aspirin. Two other COX-2 inhibitors, named Vioxx and Bextra, were removed from the market because they were associated with an increased risk of heart disease. For these reasons, this type of medication offers only a small advantage for a limited number of people with OA.

Older NSAIDs called nonacetylated salicylates (e.g., salsalate, trilisate) are a good choice for some people, especially those who have experienced stomach upset with other NSAIDs or those who have decreased kidney function. These medications are relatives of aspirin, although they are chemically different than regular aspirin. Nonacetylated salicylates are inexpensive and are less likely to cause upset stomach or kidney problems than many other NSAIDs. They can cause ringing in the ears, difficulty hearing, or dizziness if their levels in the blood become too high, but these side effects disappear quickly if the medication is temporarily stopped.

Many people with OA are intolerant of the side effects of NSAIDs or still have pain despite treatment with these drugs. For these people, physicians may prescribe narcotic pain medications, such as codeine, morphine, or synthetic morphine derivatives (e.g., hydrocodone, oxycodone). These medications have no anti-inflammatory effects but can treat pain very effectively. They are unlikely to cause ulcers, but can cause upset stomach, drowsiness, constipation, or other side effects. Some people believe that there is a stigma attached to taking pain medications, and many worry—unnecessarily—about becoming “addicted” to pain medication. If you are taking a narcotic painkiller on a regular basis, it is appropriate to be under the care of a pain specialist. A pain specialist can help to maximize your pain relief while avoiding the side effects and dependency linked to these medications.

If you are taking a narcotic painkiller on a regular basis, it is appropriate to be under the care of a pain specialist. A pain specialist can help to maximize your pain relief while avoiding the side effects and dependency linked to these medications.

Marijuana has a long history of medicinal use. For millennia, many cultures have used preparations of this herb to treat pain. In the United States, marijuana was widely used for this purpose as late as the 1800s. Several studies have found that marijuana does, indeed, have analgesic effects. In fact, the active ingredient in marijuana, called tetrahydrocannabinol (THC), may work as well in treating cancer pain as the narcotic medication codeine. When given to patients taking opiate pain medications, marijuana seems to enhance the pain relief associated with those medications, which could allow for the use of lower doses of opiate pain relievers in patients suffering from chronic pain. Scientists and pain specialists are currently developing new medications based on marijuana to treat pain.

To be clear, marijuana is an illegal substance in the United States. In June 2005, the U.S. Supreme Court ruled, in a 6-3 decision, that people whose doctors have prescribed marijuana for medical purposes can be arrested and prosecuted, overriding medicinal marijuana statutes in ten states. In their decision, the members of the Court emphasized that their ruling was not based on whether marijuana is effective for pain relief.

Corticosteroid injections can be very helpful in OA, and sometimes viscosupplementation injections (e.g., Hyalgan, Synvisc) can relieve knee pain if nothing else works. When pain is constant and medications and other conservative treatments offer little relief, surgical treatment should be considered. Pain and limited mobility should not be accepted as “part of the disease process.” Discuss your pain with your doctor, and seek out the best therapy together.

Viscosupplementation

A treatment option for people with osteoarthritis of the knee that involves the injection of hyaluronan, a natural component of synovial fluid, directly into the knee joint.

I have had some good results from acupuncture in the early stages. Also I found massages of the hands and feet help, as well as hot wax treatment for my hands and fingers.