Treatment for Osteoarthritis

Osteoarthritis is the most common form of arthritis affecting 25 to 30 million Americans. In fact, 14 million Americans alone suffer from osteoarthritis of the knee. There have been some major breakthroughs in the medical treatment of osteoarthritis in the last few years. Aspirin-like anti-inflammatory drugs, the so-called nonsteroidal anti-inflammatory drugs (NSAIDs), were the most commonly used drugs to treat osteoarthritis for many years. Unfortunately, while they were effective, they had a very high incidence of gastrointestinal side effects including peptic ulceration and bleeding. We are very fortunate in that, in the last few years, we have had a new group of drugs developed, the so called COX-2 specific inhibitors which are able to provide the same anti-inflammatory benefits of the older group of drugs without causing as many gastrointestinal side effects. 


Viscous supplements are a new class of medications used to treat osteoarthritis of the knee. Sodium hyaluronate (hyaluronan or HA) is a natural chemical found in your body and in joint tissues and synovial fluid that fills your joints. Your body’s own hyaluronan acts like a lubricant and shock absorber in synovial fluid of a healthy joint. There are a number of products like this which are used to treat osteoarthritis of the knee. These products are administered as injections given into the knee, sometimes under ultrasound guidance. Osteoarthritis negatively affects the quality of synovial fluid and therefore its ability to protect and lubricate your joint. The goal of a viscous supplement like sodium hyaluronate is to supplement the poor quality HA in your painful knee with additional highly purified HA. 


There are a number of over the counter medications available for the treatment of arthritis. Caution should be exercised in treating oneself, because the use of the over-the-counter anti-inflammatory drug is fraught with potential problems, in particular, because of the side effects these drugs can cause. I would urge all of you thinking about treating yourselves, to please speak to your physician before going out and buying an over-the-counter medication which, when taken in accumulative dosages, can be extremely toxic. I should also mention the use of chondroitin sulfate and glucosamine as one of the most recently touted breakthroughs in the treatment of osteoarthritis. There is some marginal anti-inflammatory benefit and improvement in symptoms in patients with osteoarthritis who use these substances. It seems in the very early cases of osteoarthritis, where the pain and stiffness have just developed in the joints, the use of chondroitin sulfate and glucosamine may have beneficial effects in reducing discomfort as well as preventing further progression of the disease. However, in the majority of cases, the improvement is minimal and does not really benefit the most advanced cases of osteoarthritis.


 For all of the above therapies to work, the patient needs to be educated on the cause of their problems. For example, if there is osteoarthritis of the hip or the knee, walking may aggravate the problem in their joints and therefore, should be avoided. Likewise, any aggravating factor that may affect the involved joints in a negative way needs to be reversed or discontinued to allow for the best outcomes. Also, patients who are overweight will certainly cause stress to their weight bearing joints over the period of a lifetime and, therefore, treating arthritis in the knees and hips involves getting the patient to try to keep their weight at an acceptable level. 


Surgical replacement of the hip and/or knee is necessary in certain patients as a last resort if the non-surgical treatment cannot give the patients the results needed to enjoy a good quality of life. In conclusion, osteoarthritis is a very treatable and, at times, preventable disorder. If anyone has pain, stiffness or swelling of any or their joints, please see your physician as soon as possible as the longer it takes to be treated, the more difficult it is to have a positive outcome.

Author: Norman B. Gaylis, M.D., F.A.C.P., M.A.C.R.