1. Exercise and Weight Loss
The first goal should be to take some pressure off the joint. One way of doing that is by strengthening the muscles around the joint. For instance, with knee arthritis, the quadriceps muscle on the front of the thigh is weakened, because the pain and swelling shuts down the muscle. The quadriceps is like a shock absorber. Think of driving a car without shocks--the ride is very jarring, isn't it? It's the same concept in the knee. As the quadriceps is weakened, less force is absorbed by the muscle. More of the force is transmitted to the joint itself, which causes more pain and swelling, which shuts down the muscle...see where this is going? It's a vicious cycle. Strengthening the muscle will thereby offload the joint and can relieve some of the pain and swelling. Oftentimes, a consult with a physical therapist is necessary to reactivate the atrophied muscles. Weight loss is another effective tool in the treatment of arthritis. Remember, each pound of weight loss is worth four pounds at the knee. Lastly, walking aids (canes, walking sticks) can also reduce joint pressures.
2. Medications
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, reduce pain. They work by blocking the cyclooxygenase (COX) pathway that produces prostaglandins that cause inflammation. Unfortunately, that also blocks the pathway that produces the lining for the stomach. Because of this, patients with a history of ulcers should take these medications with caution. Selective COX-2 inhibitors, such as celecoxib, can decrease the gastrointestinal side effects. However, all NSAIDs and COX-2 inhibitors can affect the heart or kidneys, so please ask your doctor before taking these medicines. Acetaminophen can also help with arthritis pain, but is usually less effective than the NSAIDs.
3. Braces
Sometimes arthritis in the knee is primarily on either the medial or lateral compartment. In these cases, an unloader brace can shift the contact pressures away from the painful side. For instance, a medial-compartment unloader brace works by pushing the knee into more valgus, thereby taking pressure off the bad, medial side and putting more onto the good, lateral side. However, the braces can cause skin irritation from the amount of pressure needed to change the alignment.
4. Glucosamine and Chondroitin
Glucosamine and chondroitin are the building blocks for some of the proteins found in articular cartilage. Theoretically, taking glucosamine and chondroitin can slow down cartilage breakdown. The jury is still out on this one. Some studies show that patients had decreased pain levels, while other studies show no effect. It usually takes about 3 months before you can tell if it's going to work for you. Some common side effects are gastrointestinal effects, fluid retention, skin problems and hypersensitivity reactions in people with shellfish allergies.
5. Injections
Steroid injections and viscosupplementation can both help with the pain and swelling of arthritis. Steroids also block prostaglandin production, but at an earlier point in the pathway. As a result, they have more side effects when taken by mouth. Injecting the steroid directly into the joint tends to keep most of it within in the joint, thereby reducing side effects. Viscosupplementation is the injection of a form of hyaluronic acid (HA) into the joint, usually once a week for 3 or 5 weeks. HA acts as a lubricant and shock absorber. In osteoarthritis, the joint fluid is altered, with a lower concentration of HA. The injections seek to restore a more normal joint environment. Again, the jury is still out on this one. Some studies show steroid injections are better than viscosupplementation, while others show the opposite. Furthermore, other studies show no difference.
