Osteoarthritis or degenerative joint disease is a wear and tear disease of the joints typically seen in the older adult (usually over 60 years of age). Cartilage within the joints breaks down causing pain as the bones rub against each other. Osteoarthritis is commonly found in the knees, hips, hands, spine, and feet.
Obesity is a risk factor for developing osteoarthritis in the knees and hips. These weight bearing joints carry much of the weight causing increased wear and tear. Weight loss can significantly reduce the chance of developing osteoarthritis and can alleviate pain in people who currently have osteoarthritis.
Currently osteoarthritis treatment is limited because no medications are capable of preventing or retarding the disease process. Osteoarthritis treatment involves focusing on pain relief, the maintenance of quality of life, and functional independence. Let us take a look at some of the treatments that currently exist for osteoarthritis.
Many doctors recommend acetaminophen (Tylenol) as the initial analgesic (pain medication) of choice for the treatment of osteoarthritis. Acetaminophen has very few side effects. When using acetaminophen as a pain reliever, remember to follow the directions correctly. Acetaminophen is commonly overused by patients. You are recommended to not exceed 4,000 mg of acetaminophen in a twenty-four hour period. Acetaminophen is metabolized or processed by the liver. Excess acetaminophen can cause damage to the liver. Acetaminophen is also found in other pain medications such as Darvocet, Percocet, and Tylenol Cold. In fact, acetaminophen is found in quite a few prescription pain medications.
Traditionally NSAID’s (nonsteroidal anti-inflammatory drugs) have been useful in the treatment of osteoarthritis associated pain. One major concern with the use of NSAID’s is irritation to the stomach lining. In more severe cases, gastrointestinal bleeds or ulcers may form. NSAID’s can affect the body’s blood clotting ability and interfere with kidney function. NSAID’s should always be taken with food to decrease stomach irritation or upset. Do not drink alcohol while taking NSAID’s. However, these drugs should not be taken for extended periods of time unless directed otherwise by a qualified medical provider. Some common types of NSAID’s are ibuprofen (Advil), naproxen (Aleve), and aspirin.
Cyclooxygenase-2 inhibitors (COX-2 inhibitors) are a class of NSAID’s. COX-2 inhibitors suppress arthritis pain much the same way but with less stomach irritation. Many of us know of COX-2 inhibitors but not by this name. Vioxx (refecoxib), Celebrex (celecoxib), and Bextra (valdecoxib) are COX-2 inhibitors. Vioxx and Bextra have been removed from the market. These drugs can significantly increase the risk for stroke and heart attack. Celebrex remains on the market but does have a black box warning stipulating this drug also can increase the risk for cardiovascular events and gastrointestinal bleeding.
Capsaicin (Capsagel, Zostrix) which is derived from chili peppers can be applied topically for the treatment of osteoarthritis pain. Capsaicin will cause vasodilation, itching, and burning to the skin but after repeated applications desensitization will occur, decreasing one’s pain. Methyl salicylate creams such as Ben-gay can also be used for osteoarthritis pain. Studies have shown that oral glucosamine and chondroitin supplements have a mild to moderate analgesic effect with arthritis.
For osteoarthritis patients who cannot tolerate their pain, glucocorticoid injections may be done. Glucocorticoids are similar to the hormone cortisol in the body. Glucocorticoids help alleviate pain by decreasing inflammation and swelling within the joint. Side effects are typically seen if you receive these injections too frequently.
Hyaluronan (viscosupplementation) injections can be injected directly into the joint for treatment of osteoarthritis. This medication helps supplement the synovial fluid. The synovial fluid is a lubricating fluid allowing the bones to move smoothly within the joint. This injection should relieve pain and improve your mobility of the joint. This treatment involves 3-5 shots within 5 weeks. You may experience pain and swelling after the injections but this should dissipate. Reduced osteoarthritis pain may last up to 6 months.
For patients that have decreased function and mobility of the joint, surgical intervention may be necessary. Surgical involvement should also be considered in patients whose pain has progressed to unacceptable levels. However, good surgical candidates are usually considered ideal for surgery. Certain health conditions can affect post-operative rehabilitation and healing. Surgery can hold just as much of a health risk as medications have side effects.
Osteoarthritis is not curable but there is hope for the future with advancements in medicine. Along with the above treatments for pain management, it is also important to remain active and healthy. Exercising regularly can help maintain mobility of the joint. Exercise also creates natural pain relievers such as endorphins. Pain may be a part of osteoarthritis, but pain doesn’t have to be a part of your life!