OSTEOARTHRITIS – MANAGEMENT
The management goal in osteoarthritis is to:
- reduce the pain
- maintain joint movement
- minimise disability
In synergy with general measures, medications could be quite effective in controlling osteoarthritis.
- Weight reduction: It reduces strain on the weight-bearing joints and thus produces marked improvement in symptoms.
- Rest to the joints: Proper body posture, avoidance of prolonged standing; squatting. Use of cane, walker and crutches is beneficial.
- Heat Application: It can reduce pain and stiffness in the affected joint.
- Physiotherapy and Exercise: This maintains the range of motion in the affected joints and improves strength of muscles surrounding the joint, which can result in pain relief.Medication: The role of drugs in osteoarthritis is basically to relieve pain, stiffness and delay the progress of functional disability in the disease.
- Acetaminophen (paracetamol) and NSAIDs are used to control pain. The side-effects of NSAIDs like gastric pain, nausea, vomiting, precipitation of asthma attacks can be avoided by use of newer subtype COX-2 inhibitors (Nimesulide, Celecoxib, rofecoxib).
- Glucosamine and chondroitin sulphate supplements not only prevent cartilage damage but also help in its repair.
- Though oral steroids do not play any role in treatment of osteoarthritis, local injection of long-acting steroids may provide relief. But frequent injections may be harmful and should be avoided (maximum 3 injections per year). Symptoms can get aggravated after steroid injections for sometime. This can be minimised by local application of ice.
- Intra-articular injection of sodium hyaluronate also reduces the symptoms.
- Local application of Capsaicin is also effective.
- Surgery: Osteotomy and joint replacement may be considered in advanced stages of the disease to relieve the pain and increase the mobility of joints.