The treatment of Osteoarthritis is based on hygienic-dietetic measures, physical treatments, medication treatments, local treatments and surgery.
Several expert societies have issued recommendations: EULAR in 2003 and OARSI in 2008. All agree on the importance of therapeutics without drugs.
Above all, the patient must be held accountable and educated. Self-management must be encouraged more than a passive attitude.
Best Naturals Glucosamine Chondroitin and MSM Joint Pain Relief Supplement, 90 Count
Non-pharmacological treatments
Weightloss
Arthritic patients who are overweight or obese have an increased risk of aggravation of their gonOsteoarthritis, or of the development of a contralateral gonOsteoarthritis. It is important to advise that you lose weight to an overweight or obese patient. It may be necessary the intervention of a dietitian or a nutritionist doctor in the overall treatment of the patient.
Physical exercise
Physical activity improves function and quality of life. Obviously, we must adapt the exercise to the patient's capabilities.
The increase in physical activity improves the effectiveness of the slimming regimen. In effect, the loss of weight is linked to the amount of physical exercises.
A patient can be advised of an exercise program. They are learned and planned in the consultation of a kinesitherapist, a physical doctor or a reeducation center to be applied by the patient at home. To be effective, they have to be practiced regularly.
You can advise, for example, to walk regularly.
Footwear and insoles
Flexible orthopedic insoles that absorb shocks can be useful. In case of Osteoarthritis of the internal femoro-tibial compartment, templates with lateral elevation will be recommended. High heels more than 4 cm. they are discouraged, since they favor the flessum.
Orthoses and canes
The containment of the knee can go from the simple knee brace to the rigid orthosis. The walking cane (or a simple umbrella) is useful, since it allows the articular discharge. The cane can be attached to the side opposite the arthrosic joint. This cane is recommended during the marches or during the accesses of the disease to put the joint in partial discharge.
In case of gonOsteoarthritis bilateral, in a patient can change the cane by a walker that, eventually, can have rollers.
Re-educational treatments
This treatment has several objectives:
- Fight against pain thanks to massage, physiotherapy and balneotherapy, enabling a discharge work,
- To preserve the joint and muscular mobility through the work of postures and the muscular reinforcement of the quadriceps, as well as of the other stabilizing muscle groups of the knee,
- Prevent vicious attitudes (flessum),
- Educate the patient about the interest of joint savings. Joint rest is essential in case of pain. The patient should be advised to avoid carrying heavy loads, stand for a long time, walk for a long time on uneven terrain, up and down stairs, squat and work on their knees.
Systemic treatments
Analgesics: paracetamol
The choice of analgesic treatment is based on an accurate estimate of pain. The intensity of the pains should be taken into account to prescribe an analgesic of adapted effectiveness. The recommended analgesic of first intention is paracetamol, up to 3 grams a day.
It is necessary to take repeated shots to be effective, and this should be explained to the patient. Your tolerance is good. In case of renal insufficiency or chronic alcoholism, it is convenient to adapt the doses.
Non-steroidal anti-inflammatories and Coxibs
NSAIDs should be reserved as a 2nd option in case of failure of paracetamol and / or in case of inflammatory access.
They should always be prescribed and used at the lowest effective dose and for the shortest possible time.
The choice of an NSAID should be made taking into account its safety profile and the individual risk factors of the patient.
There is no need to prescribe conventional NSAIDs or coxibs in case of an evolutive peptic ulcer or gastro-intestinal bleeding, a history of digestive bleeding or perforation during NSAID treatment.
NSAIDs are susceptible to induce an acute IR, it is necessary to remain particularly attentive with patients treated with diuretics, which present a risk of hypovolemia or impaired renal function.
In patients suffering from confirmed ischemic heart disease, peripheral arterial disease and / or history of stroke (including transient ischemic attack), coxibs are contraindicated and non-selective anti-inflammatory drugs should be used with caution.
Symptomatic anti-arthritic slow-acting
In several studies related to gonarthrosis and coxOsteoarthritis, AASAL have shown efficacy in pain and functional disability. They act after several weeks.
Some have a residual effect of 1 to 2 months when they are left and significantly reduce the use of NSAIDs.
Opioid analgesics
In case of rebellious pain, intolerance to paracetamol or counter-indication to NSAIDs, it is possible to resort to analgesics of grades 2 and 3 of WHO (weak and strong opioids).
They can allow to pass a painful episode, but they have frequent undesirable effects (nausea-vomiting, problems of higher functions, severe constipation).
Its indication and its benefit / risk ratio must be well evaluated.
Local treatments
Topics
Applied locally, NSAIDs are effective in superficial Osteoarthritis. They have fewer side effects and are better tolerated than oral NSAIDs.
viscosupplementation Hyaluronic acid
Intra-articular treatments
Analgesic treatments administered intra-articularly can also be used.
Corticoids
Used as a symptomatic treatment for all arthrotic joints, they can be injected in case of painful access to quickly relieve the patient.
Its effects usually disappear after a few weeks. In osteoarthritis of the knee, infiltration under "scopic" or ultrasound control is not necessary. Relative rest of the infiltrated joint is recommended for 24-48 hours.
Hyaluronic acid
Injections of hyaluronic acid have a delayed analgesic effect whose effect is prolonged in the medium term (from 3 - 6 months and up to 12 months) in Osteoarthritis of the knee, and are part of the recommendations of the EULAR in the symptomatic treatment of the Gonarthrosis.
Treatment with hyaluronic acid is indicated in moderate-severe gonarthrosis. It consists of three intra-articular injections spaced a week apart.
This treatment acts deferred. Its duration of action is between 6 and 12 months. Recently, unique injection forms have been developed, which have no difference in efficacy with respect to the forms that require three injections. This therapeutic effect is significantly higher than that of placebo. This treatment is well tolerated and carries few side effects. The studies related to possible structural effects are contradictory and, currently, do not allow the use of molecules with a structural purpose. There are numerous commercialized hyaluronic acids (HA). Its main difference is its molecular weight.
There is no formal proof of the superiority of high molecular weight AHs over low weight ones.
- Surgical treatments
- knee prosthesis surgery
A conservative surgery may be considered in young patients with a defect in the axis and a less developed unicompartmental Osteoarthritis. This surgery is based on centering osteotomies.
Arthroscopic lavage with debridement is controversial.
It may be necessary to resort to a knee prosthesis. This is necessary in the case of an evolved radiological anatomical osteoarthritis, a pain and / or a greater functional disability despite a well-performed medical treatment for a sufficient period of time.
The use of knee arthrodesis is exceptional, it is reserved for the failures or complications of prostheses and for patients who have a defect of the extensor device.