Osteoarthritis (OA) is a chronic, progressive disease characterized by articular cartilage destruction, which leads to joint dysfunction and disabling pain. The most commonly affected joint in the body is the knee, and 1 in 3 Americans age 60 years and older have radiographic evidence of osteoarthritis of the knee. Because people are living longer, and obesity is an epidemic in the U.S, the prevalence of OA is expected to be 40% by the year 2030. There are many conservative treatments available for OA, for patients who wish to avoid surgery as long as possible.
Physical modalities are useful in the management of knee pain associated with arthritis. Physical therapy interventions are proven to improve physical function and reduce knee pain. Techniques used are strengthening and flexibility exercises, as well as low-intensity aerobic exercises for reduction of knee pain and physical disability. In a small randomized controlled clinical trial, performing tai chi 3 times each week for a total of 3 months improved physical functioning and decreased pain in older women with OA.
Orthotics and Braces
Some patients with osteoarthritis benefit from the use of heel wedges and knee braces. In some studies, the use of a lateral heel wedge decreased patient use of medications. In addition, knee braces have been shown to have a small beneficial effect.
Glucosamine and Chondroitin Supplements
Marketed in the 1990s as disease-modifying supplements, glucosamine and chondroitin have been widely used to treat osteoarthritis. In a double-blind controlled trial, glucosamine combined with chondroitin showed some benefit for patients with mild knee osteoarthritis, and the supplements were found to be safe.
While there is little clinical evidence supporting the use of acupuncture in the treatment of arthritis, some people believe it helps. A meta-analysis did find that patients who received acupuncture felt better than those who received only usual care. Another clinical study found that after 6 months of acupuncture treatment, patients reported increased functionality and decreased pain scores.
Commonly used medications are:
- Topical therapies – These medicines allow patients to avoid many adverse side effects. Capsaicin cream (Zostrix) has been proven in clinical studies to help the pain associated with arthritis. Other commonly used agents are Aspercreme, menthol, and lidocaine patches.
- Acetaminophen – This drug, commonly known as Tylenol, is first-line therapy for treatment of the pain associated with osteoarthritis. However, because of potential to cause liver damage, acetaminophen should only be used short-term.
- COX-2 inhibitors – These drugs reduce the risk of adverse gastrointestinal effects associated with anti-inflammatory agents.
- Opioids – While only recommended for short-term use, opioids decrease pain, improve physical function, and have been proven effective.
Intra-articular corticosteroid injections provide short-term relief of many knee OA symptoms. In a review of 28 clinical studies, corticosteroid injections offered improvement in physical function and reduction in pain when compared to placebo injection. The steroidal agent works by inhibiting accumulation of inflammatory cells, blocking leukocyte secretion, reducing prostaglandin synthesis, and decreasing interleukin secretion by the synovial. Patients usually receive 2-3 injections spaced 4-6 weeks apart.
Hyaluronic Acid injections
Synovial fluid is a viscous liquid produced in the knee joint. For people with osteoarthritis, the lubrication qualities of synovial fluid decrease. Injection of hyaluronic acid into the joint replenishes this fluid, making the knee bend easier and with less pain. Many studies show that hyaluronic acid injections are beneficial. Examples include Orthovisc, Synvisc, and Euflexxa.
Crawford DC, Miller LE, & Block JE (2013). Conservative management of symptomatic knee osteoarthritis: a flawed strategy? Orthop Rev, 5(1), e2.