Osteoarthritis is a chronic condition involving eroding cartilage and secondary exposure of bone. Osteoarthritis affects millions of people around the world. Common joints that are involved in osteoarthritis include the knees and ankles (weight baring joints). Osteoarthritis is a cause of functional limitation and chronic pain.
Risk factors for osteoarthritis
There are several proven risk factors for osteoarthritis. These include obesity, genetic pre-disposition, injury to a joint and joint mal-alignment and certain chronic inflammatory joint diseases. Several occupations are considered risk factors for particular joint osteoarthritis. Examples include osteoarthritis in the wrists in drillers and hip osteoarthritis in professional football players. For more examples read this review. However, in most cases physical activity is not a risk factor for osteoarthritis, as long as there is no previous joint injury and / or previous joint malformation. Of note, there is inconclusive data regarding repetitive high impact sports. Also, there is much data regarding the protective effects of physical activity on osteoarthritis (see bellow).
Treatment of osteoarthritis
Osteoarthritis can be treated medically or surgically. Before going into the various treatment options for osteoarthritis it is important to note: there is no “quick fix” to osteoarthritis. In fact the science of medicine does not have a good treatment for osteoarthritis whatsoever. All treatments used today to treat osteoarthritis are meant to slow the process and relieve symptoms.
Medical treatment of osteoarthritis
The medical treatment of osteoarthritis is divided into core treatments and complimentary treatments.
Core treatment for osteoarthritis:
- Patient education
- Psychological, sociological and functional support
- Weight loss – People who are overweight have an elevated chance of developing osteoarthritis that is 2-3 times higher than non-obese persons. Being overweight actually poses a dual barrier in treating osteoarthritis – overweight people not only have more osteoarthritis, but also find it more difficult to be physically active. Physical activity, on the other hand, is important for both the treatment over obesity and osteoarthritis. Weight loss is a treatment for osteoarthritis on its own (and other conditions).
- Physical activity – Physical activity has been shown to reduce the symptoms of osteoarthritis in the long run. Regular low impact physical activity and strengthening the muscles around the affected joints reduce pain. It has been shown that it does not matter how the patient is convinced to perform activity, as long as they participate.
Complimentary treatment for osteoarthritis – medication:
Medication is used to complement the above mentioned core treatment for osteoarthritis and patients should understand that. Poor patient education can lead to frustration and over utilization of pain medication up to harmful side effects.
- Dypirone and acetaminophene
- Algolysin forte – A combination of propoxyphene (a weak opioid) and acetaminophene. It is quite efficient in managing pain but there is a standing FDA warning due to increased mortality reports.
- NSAIDs - Non steroidal anti-inflammatory drugs – Very common, some over the counter drugs. Examples include naproxene and iboprufen. Side effects include (among others) increased blood pressure, congestive heart failure exacerbation, gastrointestinal bleeding and impaired renal function. Some have been linked to increased cardiovascular mortality. On the other hand they are efficient pain medication. It is recommended to used NSAIDs sparsely for osteoarthritis and avoid chronic use.
- Dietary supplements – Dietary supplaments and particularly cartilage enhancing or cartilage component supplements have become very popular over recent years. The three available cartilage containing supplements are glucosamine sulfate, glucosamine hydrochloride and chondroitin sulfate. A recent review published in the American Family Physician did not recommend against trying these supplements for a 60 day period before deciding whether they worked for a particular patient or not. The NIH funded GAIT study showed potential benefit in specific groups of patients with knee osteoarthritis. Side effects of glucosamine and chondroitin compunds are reported to be minor (mainly gastric discomfort). Another issue to pay attention to is prescribing the proper dose – reported success is achieved with high doses, that often are not present in poorly supervised dietary supplements.
- Diacerein - ART 50 (trade name Artrodar) – Works by countering inflammation through IL-1. There is some data to support a trial with diacerein, and a Cochrane review from 2006 supported that. However, of note, some people do not benefit. Also, most evidence is derived from the hip joint. Side effects include loose stools. There is no FDA approval for diacerein use to date.
- Opioid pain medication – these medications should not be used routinely in osteoarthritis patients, but only for very severe exacerbations and peri-operatively.
- Injections – Treatment of osteoarthritis with injections includes several types of injections. Injections can be around the joint (anesthesia, for example) or intra-articular. Injections into joints consists of anesthesia, hyaluronic acid or steroids. Data regarding hyaluronic acid in large joints showed that repeat injections into large joints improved pain, but it is not clear whether it is better than other medication. Intra-articular steroids could have various local and systemic effects, but are considered effective in acute exacerbations.
- Topical treatment for osteoarthritis – Several ointments are used to treat osteoarthritis including caspaicin for pain and diclofenac for inflammation. There is a recent FDA warning regarding diclofenac gel and hepatic function.
- Complementary medicine – complementary medicine such as acupuncture and hot water springs have been tried with variable results. It probably does no harm in the case of osteoarthritis.
