Here are a couple of solutions that might be able to help treat osteoarthritis:
In spite of pain, it is important that people who suffer from osteoarthritis keep active. Exercise maintains range of motion and develops stress-absorbing muscles and tendons. Daily stretching exercises are very important.
Partial or complete immobilisation of a joint for relatively short periods can accelerate osteoarthritis and worsen the clinical outcome.
Progression of osteoarthritis of the hips and knees can actually be retarded by a well-planned exercise regime.
These are divided into symptomatic and disease modifying therapies. Symptomatic therapies include analgesics – painkillers such as paracetamol, and paracetamol-codeine preparations or even stronger opiate type drugs, such as tramadol, which only target pain. These drugs are very safe and may provide sufficient relief.
Anti-inflammatories, NSAIDs, which treat inflammation and pain, include aspirin and other non-steroidal anti-inflammatory drugs. These are potentially hazardous to the stomach. Newer safer drugs called COXIBs are available, including Celebrex and Arcoxia. They are less damaging to the lining of the stomach.
Cardiovascular safety of these drugs is, however, still under scrutiny and they should be used with caution in those with heart disease, high blood pressure, or strokes.
Oral cortisone is not helpful in osteoarthritis, but cortisone injections into the joint are useful when there are signs of inflammation. However, these are usually only needed occasionally.
There is some evidence that glucosamine sulphate has a role to play in pain and stiffness management. It is made from shrimp and crab shells and can therefore not be used if the patient has a seafood allergy. Chondroitin sulphate (made from bovine cartilage) may add some small further benefit.
Drugs such as antimalarials, tetracyclines and metalloproteinase inhibitors are undergoing trials for disease modification in osteoarthritis.
Hyaluronan injections are lubricants similar to joint fluid, made from rooster comb. These are expensive and are not proven to work. They are therefore not currently recommended for widespread use.
Surgery for damaged joints is very successful, with hip and knee replacements now commonplace operations. Hip replacement restores mobility and relieves pain in at least 95% of cases. Hip replacements last for at least ten to 15 years.
Other joints, such as the small joints of the fingers and even the shoulder joint are also being replaced with increasing success. A particularly successful operation can be performed for advanced osteoarthritis at the base of the thumb. An expert hand surgeon is able to craft an alternative joint surface using the patient's own tissues.
Indications for surgery are joint pain non-responsive to medical therapy, or function impairment. Age alone is not a contra-indication to surgery, but joint replacement is usually deferred in younger patients where possible.
Causes of osteoarthritis?
Reviewed by Dr Ingrid Louw, MBChB, MMed (Int), rheumatologist/physician, (private practice), June 2011