ehealthyland.com

It’s definitely horses for courses. No one knee osteoarthritis treatment works in everyone. There is no easy logical way to decide what to try, so use that gut feeling again.Effective osteoarthritis remedies include large doses of nicotinamide, glucosamine sulphate and homeopathic remedies by mouth or topically, SAMe, acupuncture, green barley powder, aloe vera and lots of other naturopathic preparations.

It is likely that multiple treatments will be more helpful, but certainly more expensive. If cost is an issue, use one thing at a time and observe yourself closely for any effects.

Osteoarthritis is a complex process that involves both inflammatory as well as mechanical factors. Initial joint inflammation leads to chemical changes within the cartilage that leads to premature wearing away. When the articular cartilage wears away, the bone underneath is uncovered and rubs against bone. Small bone spurs or osteophytes may form in the joint as a result of mechanical factors.

The primary symptoms of OAK include pain, stiffness, and swelling. Patients may complain of stiffness in the knees with prolonged sitting. They may also experience pain in the knees at night. Occasionally clicking or short term locking may occur.

So what treatments are available now and what is going to be available in the future?

Unfortunately, at the present, most of our treatments currently are aimed at symptom control because we do not yet have therapies that reliably and convincingly slow down or reverse cartilage deterioration.

Physicians may prescribe medicine to help control. Acetaminophen (Tylenol) is a mild analgesic (pain reliever) with few side effects if the drug is not taken on a chronic basis. Some people may also get relief of pain with over-the-counter anti-inflammatory medications, such as ibuprofen and aspirin.

Other anti-inflammatory medicines such as COX-2 inhibitors don’t cause as much stomach upset and other intestinal problems like standard anti-inflammatory drugs do. Insurance companies, though, are reluctant to pay for these since they are more expensive than standard anti-inflammatory drugs.

Medical studies have shown that glucosamine and chondroitin sulfate can also help people with knee OA. These supplements seem to have nearly the same benefits as anti-inflammatory medicine with fewer side effects. While the research results are mixed, many people find relief with these supplements.

Osteoarthritis (OA) of the knee is one of the most common maladies seen in a rheumatology office. The standard forms of treatment include non-steroidal anti-inflammatory drugs (NSAIDS), topical analgesics (eg., “rubs”), injections of glucocorticoids (“cortisone”), injections of viscosupplements (lubricants) and bracing. Arthroscopic treatment – going into the joint with a small telescope and cleaning out the knee – is occasionally helpful. For advanced cases, surgery with joint replacement is needed.

However, there are other approaches that have been used that are non-invasive and can provide short term relief. These are termed “physical modalities”. These physical measures such as electrical stimulation, electroacupuncture and low level laser (“cold laser”) therapies have been reported to be helpful as an adjunctive approach to pain relief for patients with OA of the knee.

Recent evidence has surfaced supporting the role of physical modalities. A recent study reviewed a total of 33 randomized, placebo-controlled studies where OA of the knee was treated using different modalities. Treatments used in these studies included transcutaneous electrical nerve stimulation (TENS) – a low level type of electrical stimulation, electroacupuncture (EA) – where electrical impulses are delivered at specific points near and around the joint, low level laser therapy (LLLT) – also know as “cold laser”, pulsed electromagnetic fields, manual acupuncture, static magnets and ultrasound.

There was no clinically significant improvement after manual acupuncture, static magnets and ultrasound therapies, and minimal improvement with pulsed electromagnetic fields.
In contrast, there was significant clinical improvement following treatment with TENS, EA and LLLT. The improvements were about the same for all three treatments.

Knee Osteoarthritis Treatments:

1.Cartilage grafting:Surgery may be used to graft new cartilage cells into damaged regions of cartilage. At this time, the benefits of cartilage grafting in arthritic joints is still being studied. Cartilage grafting is likely to be most practical when the cartilage damage is confined to a very small area that is surrounded by normal cartilage. Current techniques are not helpful for people with large areas of thin or absent cartilage

2.Joint replacement:Surgery may be used to replace a damaged joint with an artificial joint. The most common reason for having joint replacement surgery is when pain is not controlled by a combination of nonpharmacologic and drug treatments.

Joint replacement surgery dramatically relieves pain in people with severe arthritis of the hip or knee, and this benefit appears to last for at least three years. However, it may take up to one year before the benefits of joint replacement surgery become fully apparent.

For more information about joint replacement, (see “Patient information: Total knee replacement (arthroplasty)” and “Patient information: Total hip replacement (arthroplasty)”).

3.Fusion:Surgery may be used to permanently fuse two or more bones together at a joint. This may be recommended for badly damaged joints for which joint replacement surgery is not appropriate. Fusion may be recommended for joints of the wrist and ankle and the small joints of fingers and toes.

4.Realignment:Surgery may be used to realign bones and other joint structures that have become misaligned because of long-standing arthritis. For the knee, realignment may shift weight bearing to healthier cartilage to relieve arthritis pain. This type of alignment may be recommended for younger and more active patients instead of joint replacement surgery.

5.Arthroscopy and joint irrigation:The benefit of arthroscopic surgery in people with arthritis is controversial. In one study, patients who had “real” arthroscopic treatment and joint irrigation were compared to others who had a “sham” procedure [3]. Those who had the “sham” surgery were taken to the operating room where the doctor simulated arthroscopic surgery (but did not perform the actual procedure). Post-procedure improvement in symptoms was similar in both groups.

A selected group of patients with arthritis may benefit from arthroscopy. However, people with significant arthritis are more likely to benefit from other types of surgery.

6.Arthroscopic synovectomy:Arthroscopic synovectomy is the surgical removal of the synovium (the joint lining) using an arthroscope (a thin lighted tube) that is inserted into the joint. Inflammation of the synovium appears to play a key role in arthritis in some people. Synovectomy may be recommended for people who have inflammatory osteoarthritis that does not respond to other measures.

The American Academy of Orthopaedic Surgeons (AAOS) released its recommendations in December 2008 for “best” practice guidelines. In looking at the commonly used treatments for osteoarthritis (OA), they underscored that many lack support from scientific evidence.

The AAOS guideline targets treatment for patients with OA of the knee whose disease has not progressed to the point of needing joint replacement surgery. It offers 22 treatment recommendations. The guideline is aimed at primary care physicians as well as orthopedic surgeons.

The guideline points to the importance of patient education and lifestyle modifications that have clear benefits. It recommends exercise (strength, flexibility, and aerobic). It recommends weight loss for patients with a body mass index greater than 25. Acetaminophen and nonsteroidal anti-inflammatory medications are recommended for pain relief.