Treatments for Osteoarthritis
Treatments for Osteoarthritis
The list of treatments mentioned in various sources
for Osteoarthritis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Osteoarthritis: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Osteoarthritis may include:
Hidden causes of Osteoarthritis may be incorrectly diagnosed:
Osteoarthritis: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Osteoarthritis:
Curable Types of Osteoarthritis
Possibly curable types of Osteoarthritis may include:
Osteoarthritis: Research Doctors & Specialists
- Bone, Joint and Orthopedic Specialists:
- Arthritis & Joint Health Specialists (Rheumatology):
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Osteoarthritis:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Osteoarthritis include:
- Acetic acid
- Diclofenac
- Etodolac
- Indomethacin
- Nabumetone
- Sulindac
- Tolmetin
- Apo-Diclo
- Arthrotec
- Cataflam
- Novo-Difenac
- Nu-Diclo
- Voltaren
- Voltaren Ophthalmic
- Voltaren SR
- Voltaren Timed Release
- Lodine
- Lodine XL
- Apo-Indomethacin
- Indameth
- Indocid
- Indocid-SR
- Indocid PDA
- Indocin
- Indocin-SR
- Novo-Methacin
- Nu-Indo
- Zendole
- Apo-Nabumetone
- Novo-Nabumetone
- Nu-Nabumetone
- PMS-Nabumetone
- Relafen
- Apo-Sulin
- Coinoril
- Novo-Sundac
- Tolectin
- Tolectin DS
- Tolectin 600
- Celecoxib
- Celebrex
- Rofecoxib
- Vioxx
- Valdecoxib
- Bextra
- Fenamate
- Meclofenamate
- Meclodium
- Meclofenaf
- Meclomen
- Mefenamic Acid
- Apo-Mefanamic
- Novo-Mefanamic
- Ponstel
- Ponstan
- Oxicams
- Alti-Piroxicam
- Apo-Piroxicam
- Brexidol
- Dom-Piroxicam
- Feldene
- Med-Pirocam
- Novo-Pirocam
- Nu-Pirox
- Propionic Acid
- Fenoprofen
- Nalfon
- Flurbiprofen
- Ansaid
- Apo-Flurbiprofen
- Froben
- Froben-SR
- Novo-Flurbiprofen
- Ocufen
- Ibuprofen
- Aches-N-Pain
- Actiprofen
- Advil
- Advil Migraine
- Amersol
- Apo-Ibuprofen
- Arthritis Foundation Pain Reliever/Fever Reducer
- Bayer Select
- Children's Advil
- Children's Motrin
- Children's Motrin Drops
- Children's Motrin Suspension
- CoAdvil
- Excedrin IB
- Genpril
- Guildprofen
- Haltran
- Ibu
- Ibuprohm
- Junior Strength Motrin Caplets
- Medipren
- Medi-Profen
- Profen-IB
- Rufen
- Superior Pain Medicine
- Supreme Pain Medicine
- Tab-Profen
- Ketoprofen
- Actron
- Apo-Keto
- Apo-Keto E
- Orudis
- Orudis E-50
- Orudis E-100
- Orudis KT
- Orudis SR
- Oruvail
- Oruvail ER
- Oruvail SR
- Rhodis
- Rhodis EC
- Rhodis EC Suppository
- Naproxen
- Aleve
- Anaprox
- Anaprox DS
- Apo-Naproxen
- Naprelan
- Naprelan Once Daily
- Naprosyn
- Naxen
- Neo-Prox
- Novo-Naprox
- Nu-Naprox
- Synflex
- Oxaprozin
- Daypro
- Aspercin
- Aspercin Extra
- Bayer Aspirin Regimen Adult Low Strength
- Bayer Aspirin Regimen Children's
- Bayer Aspirin Regimen Regular Strength
- Bayer Extra Strength Arthritis Pain Regimen
- Bayer Women's Aspirin Plus Calcium
- Buffinol
- Buffinol Extra
- Ecotrin Low Strength
- Ecotrin Maximum Strength
- Sureprin 81
- Asaphen
- Asaphen E.C
- ASA 500
- Coraspir
- Capsaicin
- ArthriCare for Women Extra Moisturizine
- ArthriCare for Women Multi-Action
- ArthriCare for Women Silky Dry
- ArthriCare for Women Ultra Strength
- Capsagel
- Capzasin-HP
- Capzasin-P
- Zostrix
- Zostrix-HP
- Antiphogistine Rub A-535 Capsaicin
- Choline Magnesium Trisalicylate
- Trilisate
- Choline Salicylate
- Teejel
- Diflunisal
- Dolobid
- Apo-Diflunisal
- Novo-Diflunisal
- Nu-Diflunisal
- Meloxicam
- Mobic
- Mobicox
- Aflamid
- Masflex
- Tiaprofenic Acid
- Albert Tiafen
- Apo-Tiaprofenic
- Dom-Tiaprofenic
- Novo-Tiaprofenic
- Nu-Tiaprofenic
- PMS-Tiaprofenic
- Surgam
- Surgam SR
- Tiaprofenic-200
- Tiaprofenic-300
Latest treatments for Osteoarthritis:
The following are some of the latest treatments for Osteoarthritis:
Medical news summaries about treatments for Osteoarthritis:
The following medical news items
are relevant to treatment of Osteoarthritis:
Discussion of treatments for Osteoarthritis:
Handout on Health Osteoarthritis: NIAMS (Excerpt)
Despite these challenges, most people with osteoarthritis
can lead active and productive lives. They succeed by using
osteoarthritis treatment strategies such as
(Source: excerpt from
Handout on Health Osteoarthritis: NIAMS)
Handout on Health Osteoarthritis: NIAMS (Excerpt)
Most successful treatment programs involve a combination
of treatments tailored to the patient's needs, lifestyle, and health.
Osteoarthritis treatment has four general goals:
-
Control pain through drugs and other
measures.
-
Improve joint care through rest and
exercise.
-
Maintain an acceptable body weight.
-
Achieve a healthy lifestyle.
Osteoarthritis treatment plans often include ways to
manage pain and improve function. Such plans can involve exercise, rest
and joint care, pain relief, weight control, medications, surgery, and
nontraditional treatment approaches.
Exercise: Research shows that one of the best
treatments for osteoarthritis is exercise. This activity can improve
mood and outlook, decrease pain, increase flexibility, improve the heart
and blood flow, maintain weight, and promote general physical fitness.
It is also inexpensive and, if done correctly, has few negative side
effects. The amount and form of exercise will depend on which joints are
involved, how stable the joints are, and whether a joint replacement has
already been done. (See Be a Winner! Practice Self-Care and Keep a
Good-Health Attitude.)
Rest and Joint Care: Treatment plans include
regularly scheduled rest. Patients must learn to recognize the body's
signals, and know when to stop or slow down. This prevents pain caused
by overexercising. Some patients find that relaxation techniques, stress
reduction, and biofeedback help. Some use canes and splints to protect
joints and take pressure off them. Splints or braces provide extra
support for weakened joints. They also keep the joint in proper position
during sleep or activity. Splints must be used for limited periods
because joints and muscles need to be exercised to prevent stiffness and
weakness. An occupational therapist or a doctor can help the patient get
a properly fitting splint.
(Source: excerpt from Handout on Health Osteoarthritis: NIAMS)
Handout on Health Osteoarthritis: NIAMS (Excerpt)
Pain Relief: People with osteoarthritis may have
nonmedical ways to relieve pain. Patients can use warm towels, hot
packs, or a warm bath or shower to apply moist heat to the joint. This
can relieve pain and stiffness. In some cases, cold packs (a bag of ice
or frozen vegetables wrapped in a towel) can relieve pain or numb the
sore area. (Check with a doctor or physical therapist to find out if
heat or cold is the best treatment.) Water therapy in a heated pool or
whirlpool may also relieve pain and stiffness. For osteoarthritis in the
knee, patients may wear insoles or cushioned shoes to redistribute
weight and reduce joint stress.
Weight Control: Osteoarthritis patients who are
overweight or obese need to lose weight. Weight loss can reduce stress
on weight-bearing joints and limit further injury. A dietician can help
patients develop healthy eating habits. A healthy diet and regular
exercise help reduce weight.
Medicines: Doctors use medicines to eliminate or
reduce pain and to improve functioning. Doctors consider a number of
factors when choosing medicines for their patients with osteoarthritis.
Two important factors are the nature of the pain and potential drug side
effects. Patients must use medicines carefully and tell doctors about
any changes that occur.
The following types of medicines are commonly used in
treating osteoarthritis:
-
NSAIDs (Nonsteroidal anti-inflammatory drugs).
Many NSAIDs are used to treat osteoarthritis. Patients can buy some
over the counter (for example, aspirin, Advil®*, Motrin® IB, Aleve®,
ketoprofen). Others need a prescription. These drugs work in a similar
way: they fight inflammation or swelling and relieve pain. However,
each NSAID is a different chemical, and has slightly different effects
in the body.
* Note: Brand names included in this booklet are
provided as examples only. Their inclusion does not mean they are
endorsed by the National Institutes of Health or any other Government
agency. Also, if a certain brand name is not mentioned, this does not
mean or imply that the product is unsatisfactory.
Side
effects. NSAIDs can cause stomach irritation or affect kidney
function. The longer a person uses NSAIDs, the more likely he or she
is to have side effects, and the more serious those effects can be.
Many other drugs cannot be taken with NSAIDs, because NSAIDs alter the
way the body uses or gets rid of these drugs. NSAIDs are associated
with serious gastrointestinal problems, including ulcers, bleeding,
and perforation. They should be used with caution in people over 65
and in those with any history of ulcers or gastrointestinal bleeding.
COX-2 inhibitors. Two new NSAIDs, Celebrex® and
Vioxx®, from a class of drugs known as COX-2 inhibitors, are now being
used against osteoarthritis. These medicines reduce inflammation like
traditional NSAIDs, but cause fewer gastrointestinal side effects.
-
Acetaminophen. A non-anti-inflammatory
pain reliever (for example, Tylenol®). This drug does not irritate the
stomach and is less likely than NSAIDs to cause long-term side
effects. Research has shown that in many patients with osteoarthritis,
acetaminophen relieves pain as effectively as NSAIDs.
Warning: Patients with liver disease, heavy
alcohol drinkers, and those on blood-thinning medicines should use
acetaminophen with caution.
-
Other Medicines. Doctors may prescribe several
other medicines for osteoarthritis. They include
Topical
pain-relieving creams, rubs, and sprays (for example,
capsaicin cream) applied directly to the skin.
Mild
narcotic painkillers, which--while very effective--are
addictive and rarely used.
Corticosteroids,
powerful anti-inflammatory hormones made naturally in the body or man
made for use as drugs. Corticosteroids are typically injected into
affected joints to relieve pain temporarily. This is a short-term
measure, not recommended for more than two or three times per year.
Hyaluronic acid, a new medicine for joint injection, used to
treat osteoarthritis of the knee. This substance is a normal component
of the joint, involved in joint lubrication and nutrition. Many
patients experience pain relief after a series of three to five
injections.
(Source: excerpt from
Handout on Health Osteoarthritis: NIAMS)
Handout on Health Osteoarthritis: NIAMS (Excerpt)
|
Treatment Approaches to Osteoarthritis
|
(Source: excerpt from
Handout on Health Osteoarthritis: NIAMS)
Handout on Health Osteoarthritis: NIAMS (Excerpt)
Surgery: For some people, surgery helps relieve the
pain and disability of osteoarthritis. Surgery may be performed to
-
Resurface (smooth out) bones.
-
Reposition bones.
-
Replace joints. Surgeons may replace affected joints
with artificial joints called prostheses. These joints can be made
from metal alloys, high-density plastic, and ceramic material, and can
be joined to bone surfaces by special cements. Artificial joints can
last from 10 to 15 years or more. About 10 percent may need revision.
Surgeons choose the design and components of prostheses according to
their patient's weight, sex, age, activity level, and other medical
conditions.
-
Remove loose pieces of bone or cartilage from the joint
to improve joint function.
(Source: excerpt from
Handout on Health Osteoarthritis: NIAMS)
Handout on Health Osteoarthritis: NIAMS (Excerpt)
The decision to use surgery depends on several things.
Both surgeon and patient consider the patient's level of disability,
intensity of pain, interference with lifestyle, age, and occupation.
Currently, more than 80 percent of osteoarthritis surgery cases involve
replacing the hip or knee joint. After surgery and rehabilitation, the
patient usually feels less pain and swelling, and can move more easily.
Nontraditional Approaches: Among the alternative
therapies for treating osteoarthritis are
-
Acupuncture. Some people have found pain relief using
acupuncture (the use of fine needles inserted at specific points on
the skin). Preliminary research shows that acupuncture may be a useful
component in an osteoarthritis treatment plan for some patients. (See
the Current Research section.)
-
Folk Remedies. Some patients seek alternative therapies
for their pain and disability. Some of these alternative therapies
have included wearing copper bracelets, drinking herbal teas, and
taking mud baths. While these practices are not harmful, some can be
expensive. They also cause delays in seeking medical treatment. To
date, no scientific research shows these approaches to be helpful in
treating osteoarthritis.
(Source: excerpt from
Handout on Health Osteoarthritis: NIAMS)
Do I have Arthritis: NIAMS (Excerpt)
Sometimes you might still have pain after using your
medicine. Here are some things to try:
If you still hurt after using your medicine correctly
and doing one or more of these things, call your doctor. Another kind
of medicine might work better for you. Some people can also benefit
from surgery, such as joint replacement. (Source: excerpt from Do I have Arthritis: NIAMS)
Questions and Answers About Knee Problems: NIAMS (Excerpt)
Most often osteoarthritis of the knee is treated with
pain-reducing medicines, such as aspirin or acetaminophen (Tylenol*);
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
(Motrin, Nuprin, Advil); and exercises to restore joint movement and
strengthen the knee. Losing excess weight can also help people with
osteoarthritis.
(Source: excerpt from Questions and Answers About Knee Problems: NIAMS)
Arthritis: NWHIC (Excerpt)
Treatments for arthritis work to reduce pain and swelling, keep joints
moving safely, and avoid further damage to joints. Treatments include
medicines, special exercise, use of heat or cold, weight control, and
surgery.
Medicines help relieve pain and reduce swelling. Acetaminophen or ACT
should be the first drug used to control pain in patients with
osteoarthritis (OA). Patients with OA who don’t respond to ACT and
patients with RA and gout are most commonly treated with nonsteroidal
anti-inflammatory drugs such as ibuprofen. People taking medicine for any
form of arthritis should limit the amount of alcohol they drink since
these agents can irritate the stomach. (For more information, see the Age
Page "Arthritis Medicines.")
Exercise, such as a daily walk or swim, helps keep joints moving,
reduces pain, and strengthens muscles around the joints. Rest is also
important for the joints affected by arthritis. Physical therapists can
develop personal programs that balance exercise and rest.
Many people find that soaking in a warm bath, swimming in a heated
pool, or applying heat or cold to the area around the joint helps reduce
pain. Controlling or losing weight can reduce the stress on joints and can
help avoid further damage.
When damage to the joints becomes disabling or when other treatments
fail to reduce pain, your doctor may suggest surgery. Surgeons can repair
or replace damaged joints with artificial ones. The most common operations
are hip and knee replacements.
(Source: excerpt from Arthritis: NWHIC)
Arthritis: NWHIC (Excerpt)
In the past, doctors often advised arthritis patients to rest and avoid
exercise. Rest remains important, especially during flares. But doing
nothing results in weak muscles, stiff joints, reduced mobility, and lost
vitality. Now, rheumatologists routinely advise a balance of physical
activity and rest. Exercise offers physical
and psychological benefits that include improved overall fitness and
well-being, increased mobility, and better sleep.
Joints require motion to stay healthy. That's why doctors advise
arthritis patients to do range-of-motion, or flexibility, exercises every
day--even during flares. Painful or swollen joints should be moved gently,
however.
Strengthening and endurance activities are also recommended, but should
be limited or avoided during flares. Arthritis patients should consult
their doctors before starting an exercise program, and begin
gradually. (Source: excerpt from Arthritis: NWHIC)
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Psoriatic arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In mild psoriatic arthritis, treatment is supportive and consists of immobilization through bed rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other nonsteroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. Gold salts and, most commonly, methotrexate therapy are effective in treating both the articular and cutaneous effects of psoriatic arthritis. Antimalarials are contraindicated because they can provoke exfoliative dermatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rheumatoid arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Salicylates, particularly aspirin, are the mainstay of RA therapy because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatory drugs (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), gold salts, penicillamine, and corticosteroids (prednisone). Immunosuppressants, such as cyclophosphamide, methotrexate, and azathioprine, are also therapeutic and are being used more commonly in early disease. (See Drug therapy for arthritis.)
Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises forestalls joint function loss; application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.
Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty.
Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between the metacarpophalangeal and proximal interphalangeal joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and pain relief. Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of this disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses. Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. (See When arthritis requires surgery.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Osteoarthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is aimed at relieving pain, maintaining or improving mobility, and minimizing disability. Medications include nonsteroidal anti-inflammatory drugs, Cox-2 inhibitors and, in some cases, intra-articular injections of corticosteroids. Studies indicate that glucosamine and chondroitin may be useful in controlling symptoms and reducing functional impairment. Injecting artificial joint fluid into the knee can provide relief of pain for up to 6 months.
Effective treatment also reduces stress by weight loss and supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Exercise, such as through physical therapy, is integral to maintaining or improving joint mobility. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques to prevent undue stress on the joints, and adequate rest (particularly after activity).
Surgical treatment, such as one of the following, is reserved for patients who have severe disability or uncontrollable pain:
❑ Arthroplasty (partial or total): replacement of deteriorated part of joint with prosthetic appliance
❑ Arthrodesis: surgical fusion of bones, used primarily in spine (laminectomy)
❑ Osteoplasty: scraping and lavage of deteriorated bone from joint
❑ Osteotomy: change in alignment of bone to relieve stress by excision of wedge of bone or cutting of bone.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Juvenile rheumatoid arthritis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Successful management of JRA usually involves administration of anti-inflammatory drugs, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. Both child and parents must be involved in therapy.
Aspirin is the initial drug of choice, with dosage based on the child’s weight. However, other nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. If these prove ineffective, gold salts, hydroxychloroquine, and penicillamine may be tried. Because of adverse effects, steroids are generally reserved for treatment of systemic complications, such as pericarditis or iritis, that are resistant to NSAIDs. Corticosteroids and mydriatic drugs are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated. (See Drug therapy for arthritis, pages 367 and 368.)
Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.
Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation. (See When arthritis requires surgery, page 369.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Psoriatic arthritis:
Treatment
(Handbook of Diseases)
In mild psoriatic arthritis, treatment is supportive and consists of immobilization through joint rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other non-steroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rheumatoid arthritis:
Treatment
(Handbook of Diseases)
Salicylates, particularly aspirin, are the mainstay of RA therapy, because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatories (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), sulfasalazine, gold salts, and corticosteroids (prednisone). (See Drug therapy for arthritis.)
Immunosuppressants — such as methotrexate, cyclosporine, and azathioprine — are also therapeutic. They’re being used more commonly early in the disease process. Cox-2 inhibitors, such as rofecoxib and celecoxib, significantly reduce the risk of GI bleeding. Cyclophosphamide, which suppresses the immune system and is associated with toxic adverse effects, may be used in patients who have been unsuccessful with other therapies.
UNDER STUDY: A number of new drugs are becoming popular for RA therapy:
❑ Etanercept, an injectable, and infliximab, given I.V. every 2 months, inhibit the inflammatory protein tumor necrosis factor.
❑ Leflunomide blocks the growth of new cells.
❑ Anakinra, an injectable, blocks another inflammatory protein, interleukin-1.
Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program, including range-of-motion exercises and carefully individualized therapeutic exercises, forestalls loss of joint function.
Application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.
Treatment in advanced disease
Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty. (See When arthritis requires surgery, page 743.)
Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between MCP and PIP joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and relief of pain.
Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of the disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses.
Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. Apheresis may slow down RA or stop it from wor-sening.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Osteoarthritis:
Treatment
(Handbook of Diseases)
The goal of treatment is to relieve pain, maintain or improve mobility, and minimize disability. Medications include various nonsteroidal, antiinflammatory drugs (NSAIDs).
UNDER STUDY: COX-2 inhibitors, such as celecoxib, rofecoxiob, and valdecoxib are part of a new class of drugs that have the anti-inflammatory effects of NSAIDS but produce less stomach irritation. Many patients also benefit from such over-the-counter remedies as glucosamine and chondroitin sulfate. However, although many agents are helpful in controlling pain, they don’t appear to stimulate growth of new cartilage.
In some cases, intra-articular injections of corticosteroids given every 4 to 6 months are used to reduce inflammation and pain. Artificial joint fluid, such as Synvisc and Hyalgan, can also be injected into the knee and can result in temporary relief of pain for up to 6 months.
Usually, a 2-week trial period is needed to evaluate the benefit of a particular medication.
Effective treatment also reduces stress by supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques for preventing undue stress on the joints, adequate rest (particularly after activity) and, occasionally, exercise when the knees are affected.
Surgical treatment, reserved for patients who have severe disability or uncontrollable pain, may include the following:
❑ arthroplasty (partial or total): replacement of the deteriorated part of the joint with a prosthetic appliance
❑ arthrodesis: surgical fusion of bones; used primarily in the spine (laminectomy)
❑ osteoplasty: scraping and lavage of deteriorated bone from the joint
❑ osteotomy: change in alignment of the bone to relieve stress by excision of a wedge of bone or cutting of bone.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Juvenile rheumatoid arthritis:
Treatment
(Handbook of Diseases)
Successful management of JRA usually involves administration of an anti-inflammatory, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. The child and his parents must be involved in therapy.
A nonsteroidal anti-inflammatory drug (NSAID) — such as aspirin, ibuprofen, or naproxen — is used to reduce pain and swelling. If this proves ineffective, a disease-modifying antirheumatic drug (DMARD), such as methotrexate, is a useful second-line agent. In addition, gold salts, hydroxychloroquine, auranofin, aurothioglucose, etanercept, or sulfasalazine may be considered. Responses to individual drugs may differ among the various subtypes of JRA. Because of adverse effects, systemic steroids are generally reserved for treatment of systemic complications that are resistant to NSAIDs and DMARDS, such as pericarditis and iritis. However, an intra-articular steroid can be effective in managing pauciarticular and polyarticular JRA.
CLINICAL TIP: Joint rest (by splinting) used for up to 3 days after joint injections with a corticosteroid may improve anti-inflamma-tory response.
Corticosteroids and mydriatics are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated.
Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.
Generally, the prognosis for JRA is good, although disabilities can occur. Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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