Osteoarthritis medical therapy
|
Osteoarthritis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Osteoarthritis medical therapy On the Web |
|
American Roentgen Ray Society Images of Osteoarthritis medical therapy |
|
Risk calculators and risk factors for Osteoarthritis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2], Irfan Dotani [3].
Overview
As all 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 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 invasive 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 results in short-term pain reduction, and improvement in physical function in the diseased joint to preserve its the ability for daily tasks like walking, dressing, and even bathing. Having moderate activity strengthens the muscles around the diseased joint and this reduces stress and increases the stability of the joint system. On the other hand, resting is another important healing factor in OA. Bracing and splinting as other 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[1][2][3].
Pharmacological
Drug therapy in OA management plays an important role in relieving pain and slow downing the progression of this disease. Meanwhile, common medications are [4][5][6]:
- 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 finding in OA.
- Meanwhile, the Glucosamine and Chondroitin Sulfate supplements are used in the United States as an alternative treatment for OA. 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 a limited variety of side effects for patients.
- Topical analgesics: These creams are usually used to reduce the pain in the diseased joint. They applied directly to the skin over the affected area. These creams consist of counterirritants (wintergreen and eucalyptus) which have a great effect 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 by injecting into the joint and reduce the inflammation, swelling, and pain in the 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 other surgical interventions
- Continuing the physical therapy
II: Diagnostic
In cases having an uncertain pain especially 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. However, if the hip pain persisted after injection then other problems originating from the spine or the sacroiliac joint (the spine and pelvis) could be 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 has complications like breaking down the tissues, such as articular cartilage in the joint. Due to the important role of cartilage in joint system, most doctors refuse to use frequent cortisone injections in the same joint in a short period of time.
References
- ↑ Lauche R, Cramer H, Langhorst J, Dobos G (January 2014). "A systematic review and meta-analysis of medical leech therapy for osteoarthritis of the knee". Clin J Pain. 30 (1): 63–72. doi:10.1097/AJP.0b013e31828440ce. PMID 23446069.
- ↑ Lauche R, Langhorst J, Dobos G, Cramer H (August 2013). "A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee". Complement Ther Med. 21 (4): 396–406. doi:10.1016/j.ctim.2013.06.001. PMID 23876571.
- ↑ Zhang Y, Huang L, Su Y, Zhan Z, Li Y, Lai X (2017). "The Effects of Traditional Chinese Exercise in Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis". PLoS ONE. 12 (1): e0170237. doi:10.1371/journal.pone.0170237. PMC 5266306. PMID 28121996.
- ↑ Watson M, Brookes ST, Faulkner A, Kirwan J (July 2007). "WITHDRAWN: Non-aspirin, non-steroidal anti-inflammatory drugs for treating osteoarthritis of the knee". Cochrane Database Syst Rev (1): CD000142. doi:10.1002/14651858.CD000142.pub2. PMID 17636601.
- ↑ Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, Hochberg MC, Wells G (April 2005). "Glucosamine therapy for treating osteoarthritis". Cochrane Database Syst Rev (2): CD002946. doi:10.1002/14651858.CD002946.pub2. PMID 15846645.
- ↑ Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G (January 2006). "Acetaminophen for osteoarthritis". Cochrane Database Syst Rev (1): CD004257. doi:10.1002/14651858.CD004257.pub2. PMID 16437479.