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Medications for arthritis
The mainstay for medical treatment of osteoarthritis is the nonsteroidal anti-inflammatory drug (NSAID). These medications are all pain relievers as well as inflammation reducers. Both of these actions can help the person with arthritis feel better and enjoy more activity, but none of the medications are without side effects.
Bracing and Orthotics
Osteoarthritis in the knee is usually associated with alignment problems. The most common misalignment is varus (bowleggedness). When standing on that leg, the weight of the body is not centered in the knee, but instead is concentrated in the medial compartment. This causes the knee to wear out medially (the inner aspect of the leg). In many individuals with varus the knee shifts even more when weight bearing causing a feeling of instability, lack of confidence in the knee, and more pain. If the knee has excessive valgus (knock-kneed) the same progression occurs on the lateral (outer aspect) of the knee. Bracing and/or orthotics are usually used in conjunction with other conservative measures such as medication, exercise or injection.
Orthopedic physical therapists are knowledgeable and talented professionals who contribute to the treatment of many painful conditions of the knee including osteoarthritis. Their contributions are too numerous to mention in this short passage. The main contributions are in maximizing function and reducing pain through exercise, massage, and many additional modalities as well as education and establishment of independent exercise programs. We use physical therapy in all aspects of care, especially in recovery from injury, arthritis exacerbation and surgery.
Cortisone and other steroid injections have been used for many years for arthritic pain. It is a strong anti-inflammatory medication that is absorbed into the knee joint lining and decreases the swelling and aching pain frequently associated with flares of arthritis. It is especially helpful in inflammatory arthritis such as rheumatoid arthritis, gout or pseudogout. It is useful in advanced osteoarthritis when there is a flare of acute pain. It may help delay the need for a knee replacement, or be a means of treatment for patients who are not healthy enough for surgery. There is a known side effect of joint surface cartilage softening and therefore is not a good choice in early arthritis in younger people. There is a risk of infection in any joint injection so it must be placed using sterile means.
These thick gel-like preparations are the product of the combs of chickens or they can be synthetically produced. They have been used for over ten years with good success in the properly selected patient with osteoarthritis. Unlike the steroid injection it does not work in days, but it usually takes 4-6 weeks to get the desired pain relief. The injections are given in a series of three to five, each spaced a week apart. If a good response is achieved, it will typically last for 6-8 months. The indication for their use is osteoarthritis with persistent pain despite conservative measures such as NSAIDS, or the inability to take NSAIDs. The patient’s knee x-rays should show at least some joint space remaining, as this is not usually effective if the knee is bone on bone. The preparation is a natural product and is chemically similar to the normal lubricant we have in our knee. It is felt to decrease friction in the knee, but the main benefits for pain relief seem to be related to the decrease in inflammation seen in 4- 6 weeks. Unlike the steroid injection it has not been shown to cause any joint surface injury and theoretically may help the joint. Therefore it is safe in younger individuals with less severe forms of osteoarthritis. The injections can be repeated every six months as long as they are effective and can delay the need for a joint replacement. Ultimately the relief obtained becomes unsatisfactory as the joint surface is lost and the knee becomes” bone on bone”.
The stresses across the knee joint are directly related to body weight and the length of time that the weight exceeds ideal body weight. This factor is even greater in the patella-femoral (kneecap) part of the joint. This can become a real problem as a painful arthritic knee doesn’t allow a person to exercise. The lack of ability to exercise makes it very difficult to lose weight. It is very important to keep your weight under good control, especially if you have other risk factors such as previous knee injury, positive family history of knee arthritis or poor knee alignment. Many people find themselves in this predicament of being overweight and having knee arthritis. We can treat the arthritis using all of the previous listed methods as well as diet modification, however, we may need to proceed with surgical treatment. If surgery is recommended increased body weight escalates your surgical risk of infection and development of post operative blood clots.