TOC  |  Rheumatology  

Osteoarthritis Management                                                                                  See  Pain / NSAID Med

• Reassurance and education
• Physical therapy
• Reduction of stress on joints can relieve pain and may affect outcome favorably. Obese patients with lower limb disease should be helped to lose weight. Use of a cane can reduce loading on the contralateral hip or knee by 30% to 60%. The use of shock absorbing insoles may help, and adjustments to shoes to help correct any leg length inequality or angulation deformity can be valuable. Activities that involve repetitive impact loading or result in prolonged post-exercise pain should probably be avoided.
• Pain / NSAID Medications are helpful.
• Intra-articular corticosteroid injections.
• Viscosupplementation with Hylan G-F 20 (Synvisc) 2 ml intra-articular administration to knees
  once/week for total of 3 injections.
  For resting pain relief, intra-articular 2 mL of 10 mg/mL hyaluronate sodium seems to be as effective as NSAIDs. Further, for pain with physical activity and functional performance, hyaluronate sodium may be superior to placebo alone or NSAIDs alone.
  Arch Intern Med. Feb. 11, 2002;162:292-298  
• Laproscopic joint surgery
• Surgery as joint replacement is of great value in advanced large joint OA.

REF:
ACP Library on Disk 2- (c) 1997 - American College of Physicians         
New Horizons in the Treatment of  Osteoarthritis of the Knee - JAMA 3/10/1999;281 (10):876 Robert F. LaPrade

Viscosupplementation with Intraarticular hylan G-F 20 for the treatment of osteoarthritis: findings from clinical practice in Canada.
Lussier A, Cividino AA  -  J Rheumatol 1996 Sep;23(9):1579-85

A total of 1537 injections were performed in 336 patients involving 458 knees. The overall response and the change of activity level were judged better or much better for 77 and 76% of the treated knees after the first course of treatment (3 weekly injections), and 87 and 84% after a 2nd course. The mean time elapsing between the first and 2nd course, 8.2 +/- 0.5 months, is an evaluation of the duration of benefits. Local adverse events were observed in 28 patients (32 knees), with an overall rate of 2.7% adverse events per injection, 7.0% per joint, and 8.3% per patient. No systemic adverse events were noted in any patient. The adverse events were characterized by pain and/or transient swelling of the injected joint, mostly mild or moderate in intensity, and 72% of the adverse events were considered to be possibly or probably related to the injection. The incidence of adverse events is significantly influenced by the injection technique: 5.2% adverse events per injection with a medial approach to a partially bent knee, and 2.4% (straight medial) and 1.5% (straight lateral). After an adverse event, clinical improvement still occurred in 69% of the affected knees. CONCLUSION:
Hylan G-F 20 provided good clinical benefits and an acceptable safety profile in current clinical practice. The occurrence of adverse events after an intraarticular hylan injection is infrequent and unpredictable and is not necessarily hylan related, although injection related.

Is glucosamine an effective treatment for osteoarthritic pain?  (Cleveland Clinic J Med 6-2001)

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