Osteoarthritis is the most common type of arthritis affecting more than 20 million Americans. It is a condition affecting primarily weight-bearing joints such as the neck, low back, hips, and knees.

The treatment of osteoarthritis involves both drug as well as non-drug therapies.

Nondrug approaches focus on lifestyle issues such as the maintenance of proper body weight, regular exercise to maintain joint health, and patient education- learning what to do and what not to do.

Also, other simple modalities such as the use of heat or ice, assistive devices (canes, walkers, etc.), as well as physical and occupational therapy, can be useful.

Reduction of stress on the joint is a key but often forgotten treatment strategy. Occasionally, patients undertake activities that aggravate their condition unknowingly. It is critical to identify those activities and either modify or eliminate them.

Poor posture and excess weight are two important factors that worsen osteoarthritis symptoms.

Since the reflex to pain is often avoidance of activity, there is a tendency for patients with osteoarthritis to develop muscle atrophy in the muscles surrounding a painful joint. An example would be osteoarthritis of the knee where quadriceps atrophy is a common accompanying sign of the disease. Hence, strengthening of the muscles is a common and effective treatment approach.

Local measures such as heat or ice may be useful.

Drug treatment revolves around a number of different types of medicines. The aim is pain relief. Medicines used for osteoarthritis can be divided between topical agents and oral agents.

Topical drugs containing capsaicin often are helpful for minor aches and pains. More recently, preparations containing diclofenac (Voltaren gel, Pennsaid) offer non-steroidal anti-inflammatory drugs in a rub-on form. A patch that uses diclofenac (Flector) is also available.

For pain relief, patches with lidocaine, a local anesthetic might also be helpful.

Nutritional supplements such as pure forms of glucosamine and chondroitin are useful for some patients. One particular form of this compound, Joint Food, is particularly effective. In fact, I take it myself.

Oral agents such as acetaminophen (Tylenol) can be used for patients with minor pain. Unfortunately, by the time patients consult a rheumatologist, their pain is more severe than what can be relieved with acetaminophen.
Tramadol (Ultram) is the next step up for analgesic effect.

For patients requiring anti-inflammatory effect, non-steroidal anti-inflammatory drugs (NSAIDS)are used. While they are often effective, they possess many potential toxicities including stomach as well as intestinal ulcers and an increased tendency towards cardiovascular events such as heart attack and stroke. Adding a medicine called a proton pump inhibitor to the NSAID can reduce the likelihood of ulcer but does nothing to reduce the chance of heart attack or stroke.

Mild narcotic analgesics can be used if the patient has significant pain. I'm not a fan of this approach because of the chance for habituation.
Muscle relaxants for patients who have muscle spasm in the neck and low back as a result of osteoarthritis, can be helpful.

Glucocorticoids are steroids that are administered by injection to reduce pain and inflammation.

Viscosupplements are lubricants that are injected into joints such as the knee to help reduce pain and improve function. They are helpful foe people who do not have extensive arthritis.

Both glucocorticoids as well as viscosupplements should be administered using ultrasound guidance in order to ensure proper location.

The crying need is for treatments that restore cartilage. Currently, we are evaluating the ability of adult autologous (a patient's own) mesenchymal stem cells to do just that. Preliminary data from our institution looks promising. Further investigation is needed.

For patients who do not respond to the above treatments, surgical procedures may be helpful.

Osteotomy- removing a wedge of bone to help align the joint, joint resurfacing- a modified method of covering the diseased cartilage with plastic, as well as total joint replacement all have their place.