Osteoarthritis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Revision as of 17:17, 8 April 2018
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Osteoarthritis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Osteoarthritis medical therapy On the Web |
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American Roentgen Ray Society Images of Osteoarthritis medical therapy |
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Risk calculators and risk factors for Osteoarthritis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mohammadamin Rezazadehsaatlou [2].
Overview
As all medical diseases, the prevention and the early diagnosis and onetime treatment of OA play important roles patient final outcome. The treatment of OA can be categorized into two and options. Treatment options of OA are: nonsurgical (non-pharmacological, pharmacological, and complementary) and surgical interventions. As it always was, is, and will be the patients have this right to get the best, safest, and least invasivity therapies as their first treatment options. Meanwhile, Surgical interventions should be considered in patients who have responded to the first line non/less invasive therapies inadequately. Meanwhile the non-surgical treatments are often effective enough as the first line in patients management. Actually, the Osteoarthritis treatment is a combination of medical therapies.
Medical Therapy
Non-pharmacological
Nonpharmacologic therapy is consisted of physical therapy and specific type of physical exercises, bracing and splinting. Physical therapy result in short-term pain reduction, and improvement in physical function in diseased joint to preserve its the ability for daily tasks like: walking, dressing, and even bathing. Because having moderate activity strengthen the muscles around the diseased joint and this stronger muscle reduce stress and increase the stability of joint system. On the other hand, resting is an other important healing factor in OA. Bracing and splinting as another methods help to support painful or unstable joints. Using a cane can help decrease the weight pressure in diseased hip or knee, but it should be used on the contralateral side of the affected joint.
Pharmacological
Drug therapy in OA management play important rolls in relieving pain and slow downing the progression of this disease. Meanwhile, common medications are:
- NSAIDs (Non-steroidal anti-inflammatory drugs): Including: acetaminophen, aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), diclofenac, Cyclooxygenase-2 inhibitors(celecoxib (Celebrex) are used to reduce the inflammation and swelling as a common findings in OA.
- Meanwhile, the Glucosamine and Chondroitin Sulfate supplements are used in the United States as an alternative treatment for OA. And, for patients experiencing moderate-to-severe pain due to the knees osteoarthritis or spine osteoarthritis, they might be helpful by interacting with the diseased cartilage.
- Analgesics: Including: acetaminophen (e.g. Tylenol), or tramadol (e.g. Ultram) are used to reduce the pain, without any effects on inflammation or swelling. Analgesics are recommended for patients experiencing mild to moderate pain because they could cause limited variety of side effects fro patients.
- Topical analgesics: These creams are usually used to reduce the pain in diseased joint. They applied directly to the skin over the affected area. And these creams are consisted of counterrritants (wintergreen and eucalyptus) having a great effects on pain reduction. Capsaicin cream is derived from chili peppers and found to be effective in treating osteoarthritis pain which can be applied as an adjunct therapy to the OA standard treatments. This group of therapies compared to NSAIDs had fewer adverse effects.
| Medication | Typical dosage |
|---|---|
| Acetaminophen | 650 to 1,000 mg four times per day |
| Celecoxib (Celebrex) | 200 mg per day |
| Diclofenac sodium | 50 mg two to three times per day |
| Diclofenac/misoprostol (Arthrotec) | 50 mg/200 mcg two to three times per day |
| Ibuprofen, over-the-counter | 400 to 600 mg three times per day |
| Meloxicam (Mobic) | 7.5 to 15 mg per day |
| Nabumetone | 500 mg two times per day |
| Naproxen, over-the-counter (Aleve) | 220 to 440 mg two times per day |
| Naproxen (Naprosyn) | 250 to 500 mg two times per day |
| Oxaprozin (Daypro) | 1,200 mg per day |
| Sulindac (Clinoril) | 150 to 200 mg two times per day |
complementary
Cortisone are a group of man-made steroids simulating the cortisol effects in body. cortisone injections are used for two most important reasons:
- I: Treatment option
- II: Diagnostic option
I: Treatment
Steroids (corticosteroid) can be used through injecting into the joint and reduce the inflammation, swelling, and pain in diseased joint, for 6 weeks and 6 months period.. For cases with moderate to severe pain affecting patients daily life, this procedure (steroid injections) can provide very helpful and important opportunities include:
- Resting the diseased joint
- Eliminate/Decrees the arthritis flaring-up
- Postponing the joint replacement or another surgical interventions
- Continuing the physical therapy
II: Diagnostic
In cases having an uncertain pain specially in hip and shoulder joints, the cortisone could be helpful in reaching accurate diagnoses. For example, If after the injection, the patient's hip pain decreases this means the pain originates from the hip but If the hip pain persisted after injection then other problems originating from the spine or the sacroiliac joint (the spine and pelvis) could considered as the pain sources.
Complications
- The U.S. Food and Drug Administration recommends not to use more than 4,000 mg of acetaminophen/day in order to avoid its liver toxicity.
- NSAIDs could cause adverse effects such as: gastrointestinal bleeding, renal dysfunction, and blood pressure elevation.
- Steroids injection have complications like: breaking down the tissues, such as articular cartilage in the joint. Due to the important roll of cartilage in joint system, most doctors refuse to use frequent cortisone injections in the same joint in a short period of time.