What Are the Treatments for Osteoarthritis?
Learn the best treatment options for OA and find out when you should consider joint replacement surgery.
Rob Lamberts, MD
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What Are the Treatments for Osteoarthritis?
This is the second article in a series on osteoarthritis (OA). My last article, What Is Osteoarthritis?, covered the definition, causes, and diagnosis of the condition; today I’ll cover the options for treatment. OA is not only very common, affecting over half of Americans over 65, but very costly. The economic cost is huge, and even larger is the cost in terms of quality of life that it steals from its victims. So treatment is a big way to give back productive years to people who suffer from this terrible disease..
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What Are the Treatments for Osteoarthritis?
Just as there are no magic ways to prevent OA, there are no magic treatments either. The main focus of treatment is pain relief, not treating the disease itself. One of the worst consequences of OA I see in many elderly people is a significant reduction in their activity. Keeping active is strongly associated with a longer life, so treatment of the pain is aimed at maintaining as normal an activity level as possible.
One important treatment for OA is physical therapy and guided exercise. Water aerobics are especially good for elderly people with significant arthritis; it can reduce pain and increase mobility.
What Medications Are Used to Treat Osteoarthritis?
There are several levels of medications for OA, that, as mentioned, are all intended to treat the pain:
Acetaminophen – reduces pain and can be safely used as long as it is used in the proper dosage.
Anti-inflammatory medications – Medications like ibuprofen, naproxen, and the myriad of other anti-inflammatories are better than acetaminophen at reducing the pain–and they do so for longer periods. The problem is that long-term use of these medications is associated with serious stomach ulcers and kidney problems. If you use any of these in the long-term, you should also take a stomach-protecting medication.
Narcotic pain medications – some people think it is extreme to use medications like hydrocodone or oxycodone for OA, but they are very good if used carefully. It’s better to use these medications than to sit around doing nothing to avoid pain. Long-acting narcotics are safer than the short-acting varieties and can reduce the risk of addiction.
Topical medications – Capsacin, the substance that makes chili peppers hot, will reduce arthritis pain when applied to the joint. The problem is that it can cause irritation and has to be applied for a while before people have a significant benefit.
Other “natural” medications – Glucosamine with or without Condroitin has been heralded as a “natural” means to reduce arthritis pain. Unfortunately, though initial studies were optimistic, numerous follow-up studies haven’t shown it to really help. But that doesn’t mean I recommend against people using it, as it is not at all harmful and some people really feel it helps to reduce their pain. That goes for other “natural” medications as well: as long as they don’t harm you, if they make you feel better, take them. Just make sure you tell your doctor and pharmacist in case they interact with other medications you are taking.
Other Treatments for Osteoarthritis
The main focus of treatment for osteoarthritis is pain relief, not treating the disease itself.
In addition to physical therapy and medications, there are a couple of other treatment options your doctor might recommend:
Joint injection – Injection of the joint with cortisone to reduce inflammation can give temporary relief, but since OA doesn’t always have inflammation in the joint, it doesn’t last long. Newer injections with a substance called hyaluronic acid will improve the lubricating ability of the fluid in the joint and can help reduce pain, particularly with knee arthritis.
Surgery – Surgery is generally the last step taken in the process. In my experience, people wait too long before getting surgery, as it can really help reduce pain and improve quality of life. Though there are certainly risks involved whenever you get cut open, people often ignore the risk of doing nothing. Pain causes a person to slow down, and slowing down and becoming inactive greatly increases other disability and death.
There are various levels of surgery for arthritis, depending on the joint involved. Sometimes an orthopedic surgeon will use a scope to flush the joint of debris and perhaps trim off major bony abnormalities. But these surgical procedures are temporary. The mainstay of surgical treatment for arthritis is joint replacement with artificial joints (most commonly made of titanium). Hip and knee replacement are by far the most common. Shoulder replacement, and newer joint surgeries, such as those on the hand, are being done more and more. In general, the simpler the joint, the easier the surgery, which is why the knee–which is a simple hinge–and the hip–which is a ball-in-socket joint–are the most common joints replaced.
When Should You Consider Joint Replacement Surgery?
The hardest decision for a person with arthritis is when to go ahead with joint replacement. So I’ll finish this article with Quick and Dirty Tips to help you or your loved one decide when joint replacement is a good idea:
Tip 1: When it hurts enough to make you want surgery, get it done. Joints that aren’t particularly painful should not be replaced. If you can stay active and deal with the pain, you probably can wait. But if you find that your activity level is significantly dropping or you are spending a good portion of your day in pain, you should strongly consider surgery.
Tip 2: Get simpler joints done earlier. Knees and hips are simpler to replace, and getting them replaced is more likely to reduce or even eliminate pain. There is a limited lifespan on joint replacements, so people who are under 65 will have to consider more alternatives. Talk to your doctor about these issues.
Tip 3: Make sure you are getting adequate pain medications. I have been able to dramatically improve people’s quality of life and mobility by using long-acting narcotics, especially fentanyl patches and oxycontin. Don’t be afraid of treating your pain with strong medications, but make sure they are long-acting medications, as the shorter acting ones are less effective and are more addictive.
Tip 4: Only get surgery done by a doctor you trust. If you have misgivings about your surgeon or their explanations, get a second opinion. Talk to your primary care doctor or consult another surgeon. If someone is going to cut you open while you sleep, you sure had better trust them a lot.
I hope you never have to face this decision, but chances are, a lot of you will. If so, I hope this information will be useful for you.
If you have topics that you want me to cover, send them to housecalldoctor@quickanddirtytips.comcreate new email, or you can submit them to me on twitter (@housecalldoc) or my Facebook page.
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!
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