Treatment of Osteoarthritis

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The first goal of Osteoarthritis treatment is to ease the pain and functional incapacitation without side effects. The first step is to correct those modifiable risk factors that can affect compromised joints, like overweight, repeated movement or wearing the correct shoes. Second, moderate exercising is vital to increase the functionality of the joints. Lastly, correctly following the pharmacological treatment prescribed in each case. To this day no therapy that can impede osteoarthritis' progression, but medicine that alleviates pain and inflammation do exist, and some others can delay or slow cartilage decay.

The most effective measure in osteoarthritis is prevention, that is to say, to try to correct those modifiable risk factors that can speed up its process.

Weight scale with a correct weight

Avoid overweight. In the case of suffering from osteoarthritis in load-bearing joints (knee, hip, lumbar region, etc.). Occasionally, weight loss, however small, is sufficient to make an obvious improvement of the pain associated with osteoarthritis.

no subir escaleras

Do not make repetitive movements or make excessive use of the compromised joints. One example could be to avoid stairs whenever possible in patients with osteoarthritis of the knee.

higiene postural, señora sentada silla correctamente

Correct postural hygiene. For example, adjust the seating position in the workplace to preserve the anatomy of the region, or avoid spending too much time standing up if there is osteoarthritis in the lower limbs.

Woman swimming

Physical exercise. This must be individualized for each patient, and should be performed regularly, without forgetting it in the phases when the symptoms improve. For example, swimming is a good sport for patients with lumbar, hip or knee osteoarthritis. Good physiotherapy can produce a significant improvement of the pain and joint stiffness.

The most effective measure in osteoarthritis is prevention, that is to say, to try to correct those modifiable risk factors that can speed up its process.

Medicines

Analgesics. They are the most used drugs. They produce a significant improvement in the pain and joint stiffness. Common analgesics like paracetamol are normally used.

Blue, white and green pills

Anti-inflammatory drugs. Many patients have pain despite the use of analgesics and can be treated with the so-called non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, naproxen, ibuprofen, aceclofenac, etc., especially on the days when the pain is more acute. In cases where there is no response to common analgesics or non-steroidal anti-inflammatory drugs, more powerful analgesics may be used, such as opiates (for example, tramadol).

Pills with green and white stripes

Chondroprotectors. In the last few years, drugs have arrived on the market called chondroprotectors, which are constituent substances of the cartilage joint and that can alleviate the pain of osteoarthritis. However, their efficacy is still not widely accepted. Within this group are glucosamine and chondroitin sulphate. Other drugs, like diacerein could have a similar effect.

Injection

Intra-articular therapy or injections. Many patients may benefit from the administration of anti-inflammatory drugs within the joint. This is intra-articular therapy or injections. In the majority of occasions glucocorticoids, derived from cortisone, are injected, and more recently hyaluronic acid is also being used. Injections can be given in cases where the pain is not alleviated by the previous treatments. They are particularly useful in those joints where the inflammatory signs, especially joint effusion, are more evident. They should also be used as a one-off measure, and not be performed repeatedly, since the use of corticosteroids may sometimes be counter-productive in excessive doses. Their ideal use is in joints with unevolved osteoarthritis, where it is still possible to reverse certain processes. On the other hand, in very advanced osteoarthritis, where surgery is now the only option, its efficacy notably decreases.

Usually, the use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) do not involve any long-term complications for the patients, thus improving their quality of life. Analgesics like paracetamol do not have many side effects when employed in the usual doses. The weak opiates also do not usually produce significant side effects if they are used under medical supervision. Their main problem is tolerance, with there being a small percentage of patients who refer to mild gastrointestinal symptoms such as nausea and constipation associated with their consumption. Their rational use and in increasing doses minimize these effects.

Of the drugs most used in osteoarthritis, the NSAIDs are the ones that have the most long-term side effects. However, their rational use, particularly in the acute phases when the pain is more intense, notable decreases their impact. Gastritis, ulcers, or intestinal bleeding can occur, mainly in patients at risk, such as the elderly or those treated simultaneously with corticosteroids or anticoagulants. For this reason, people over 60 years of age must be provided with gastric protection with drugs, as well as those who have suffered from a previous ulcer, those that take very high doses, those that have severe chronic diseases, and those that simultaneously take anticoagulants and/or corticosteroids and/or anti-platelet drugs.

Furthermore, NSAIDs consumed continuously at high doses for years are also associated with a higher risk of hypertension, heart and kidney diseases, and liver problems.

Intra-articular therapies, performed by expert staff, hardly produce any side effects, with infection being somewhat exceptional, the most common being a slight atrophy of the skin in the area of the injection that usually reverses with time.

juanete, aparición juanete, aparición bulto en pie

Initial phases and selected cases. The course of the disease may be slowed down with surgery that corrects the orientation of the joint by making cuts in the bone (osteotomy), or by joint remodelling (as is the case of arthroscopies, in which different techniques may be used). In this field, different reconstruction options of very localized cartilage defects are being investigated, with variable results.

Prótesis de rodilla, artrosis de rodilla

Advanced osteoarthritis. In cases in which the osteoarthritis has progressed over a long time and does not improve with other treatments, the most effective surgery consists in implanting a prosthesis in the damaged joint. A prosthesis can be implanted in various joints: in the hip, the knee, the shoulder, the elbow, the wrist, or the ankle. With a suitable technique and a correct indication, excellent results are expected in the majority of cases. The implant can be anchored (fixed) to the bone with cement or by fixing it under pressure with its metal surface. In these cases, the bone grows on the surface of the implant and in a few weeks it produces a firm anchor. Occasionally, screws are used, to increase the anchoring of the metal surface.

The majority of replacements are implanted in the hip or the knee, although, in the last few years, prosthetic surgery in other joints (ankle, shoulder, wrist, etc.) has notably advanced.

The components of the prosthesis consist of a metal element (alloys of cobalt, chromium, titanium), which fit exactly into a plastic (polyethylene).

There are different types of implants and surgical techniques, and its choice by the orthopaedic surgeons will partly depend on their own experience and the characteristics of the individual patient (age, associated diseases, professional activity, etc.). In the past few years new materials and less aggressive procedures are being tested, with good results.

In general, the results of knee and hip replacements are usually excellent, with an improvement or disappearance of the pain and recovery in the mobility of the patient.

However, there can be complications, such as suffering an infection, a dislocation, etc. in a small percentage of cases, generally less than 5%. These complications are directly proportional to the age of the patient and to diseases that they suffer from, as such that younger patients and with no underlying disease have a very low risk of complications.

It should also be remembered that the patients may have resorted to surgery because they have not found any other treatment that could improve their quality of life sufficiently, and for this reason the risk /benefit profile should be taken into account.

Substantiated information by:
Jenaro A. Fernández-Valencia LabordeTraumatologist — Orthopedic Surgery and Traumatology DepartmentAnna MartínPhysiotherapist — Rehabilitation DepartmentAna MonegalRheumatologist — Rheumatology DepartmentRosa MarinaNurse — Orthopedic Surgery and Traumatology DepartmentNuria SapenaNurse — Orthopedic Surgery and Traumatology Department

Published: 20 February 2018
Updated: 20 February 2018

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