How to manage osteoarthritis? reasonable jumpstart guide

treat vs manage osteoarthritis

Note here that I am using the word manage osteoarthritis not cure or treat. Albeit there is, I think, two forms of treatment, usually we manage. What do I mean manage and treat. Manage is somewhat dealing with the issue and make it tolerable without fixing the main issue. Treatment in my mind is a form of resolving the main issue and consequently the patient feels better too. Health care providers usually prefer the latter but more frequently than we like, we do not have effective treatment.

Diet and exercise concept

To start off, treatment or management of osteoarthritis is mainly physical activity, proper diet, and healthy habits. I consider them one as they work hand in hand. They affect each other closely. If you ask any professional gym trainer, they will talk endlessly about the importance of both for both your overall health and manage osteoarthritis. I have seen memes (yes, I am a millennial) that show a gym trainer slapping a sandwich of their trainee hand. I already have articles for diet and exercise and will expand more as I go but here, I will focus on what health care providers can do for you.

Actual treatment rather than just management

The one form of osteoarthritis management, I see, is for knee osteoarthritis which uses hyaluronic acid injections in the joint. These typically provide cushioning effects and possibly even delay the need for knee replacement. Anything else I will talk about is more of management not treatment. There is more diversity in what to use based on the side effect profile of each management and patient preference. Most of my first osteoarthritis management visits are about laying out options, of course after emphasizing the point of diet, exercise, and physical therapy.

Steroids injections

Osteoarthritis as a reminder is wear and tear of joints. The cousin of osteoarthritis is tendinopathy or tendonitis. The latter is wearing out of tendons. I split these again into spinal and peripheral. Either your spine at the neck, chest, lower back, or tail bone are hurting. The other option is joints of the hands, wrists, elbows, shoulders, hips, knee, ankles, and toes hurt. Each of these has at least one location that can be injected with steroids. For medical providers it is preferable to use methylprednisolone for tendon issue and triamcinolone for actual joints but commonly used interchangeably without issues.  Medical provider slightly differs on properness of frequency of injections but generally we do not inject a single joint more frequently than every 3 months. There is one exception. At times a patient might have a severe deformity of the joint but refusing surgery and therefore the PATIENT decides to take the chance. The issue with frequent injections is that you can wear out the joints faster.

Spine vs peripheral injections

Who does these injections? General wisdom would say anything spine mainly by interventional pain clinic. Pain doctors are anesthesiologists, docs who numb us for surgeries, who do additional training to use these same amazing techniques for elective pain management of osteoarthritis. For peripheral injections, typically are done by Rheumatologists. At times, some orthopedic surgeon might inject the spine and peripheral joints but generally not spinal as it needs a special set up. Surgeons have other bigger problems to deal with. Orthopedic surgeons need to replace and fuse joints as an example. They are busy enough as is. They are however more malleable to do peripheral joint injections as these can be done in office.

Pain pills for osteoarthritis management

“But doc, my friend did not get injections, he got pills” Ok you are right. There are pills to manage pain. But think of pills as a chemical that will go through all your body. Side effects over the long term are likely larger. Who gets more osteoarthritis? You guessed right “the older the person”. The older the person, the more side-effects you can expect as the organs (liver and kidney) that get rid of meds get older too. Therefore, you might expect more side effects. But let us talk about pills. Will start from basic to more complex. So acetaminophen (paracetamol for European brethren), topical non-steroidal (like diclofenac gel), oral non-steroidal (like ibuprofen and naproxen), COX-2 inhibitor (like meloxicam), Tramadol (semi-narcotic), then narcotics. At times we use pain syndrome meds which I discussed in my fibromyalgia article.

Possible problems with pills

What is the problem with each of the above. Acetaminophen can affect the liver, so I do not prescribe it to people with liver issues. Usually, I recommend not to exceed 3000 mg a day. I usually recommend it as 1000 mg three times a day. Then NSAIDS and COX-2 inhibitors can affect the kidney and stomach but the former more. The latter, I do not prescribe to people with history of clotting in hearts or brain (heart attacks and stroke). Previously, an older COX-2 inhibitor was withdrawn from the market due to such connection to cardiovascular disease. Do not mix several non-steroidal or several COX-2 inhibitors. Do not mix non-steroidal with COX-2 inhibitor.

Osteoarthritis management in the elderly and narcotics

For older populations, tramadol and narcotics might be preferred option as aging population has less risk of addiction and they might be more sensitive to meds discussed above. However, at least in the United States, these meds became more restrictive and generally only prescribed by pain management clinics. I am one of the long-term proponents of specialized clinics in managing medications as each specialty builds a system for monitoring. When it becomes more streamlined and common enough, then it can fall back to primary care providers. Although occasionally your primary care provider might be able to help you if it is permissible within the context of their state and institution.

Summary of osteoarthritis management

Again, I want to emphasize the best management for osteoarthritis is physical therapy, dieting, and exercise. These probably need articles about them. In future articles, I am considering inviting physical therapists and nutritionists to write their perspective. I will or have touched on this in one aspect or another within the context of my experience.

Braun S, Minzlaff P, Hollweck R, Wörtler K, Imhoff AB -Arthritis research & therapy(2008)

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