Osteoarthritis- What is the best treatment? (Part II)

22 Nov Osteoarthritis- What is the best treatment? (Part II)

The first line of treatment for osteoarthritis (OA) and what everyone should be doing was explained in Osteoarthritis- What is the best treatment? (Part I). However there are many other treatment options are out there and when should we consider using them? 

Figure 1. The treatment of osteoarthritis can be shown by this pyramid. The lower part is education, exercise and weight loss (if necessary). This should be offered to anyone with osteoarthritis right away. The middle part should be offered to those who did not improve with education and exercise. Surgery (typically joint replacement) should only be offered when no other treatment has worked.

Figure 1. The treatment of osteoarthritis can be shown by this pyramid.

Second Line Treatment

This should be viewed as complementary to the primary treatment approach of education, exercise and weight management. The following treatments should not be your first and only approach to treating OA.

Medications

medicationsCommon medications that are used for pain relief include:

1. Paracetamol

2. Anti-inflammatories (NSAIDs) eg. Neurofen, Voltaren

3. Topical anti-inflammatory creams eg. Voltaren gel

NOTE:

  • Before taking any medications always consult your GP for specific advice tailored to your individual situation.
  • Medicines may only offer a short term help to your pain, they are not long lasting and should only be used in short periods at a time.
  • Oral NSAIDs have been shown to have the most affect on pain, however they also carry a higher risk or adverse affects.
  • It is NOT recommended to take any Opioids (eg Codeine, Oxycodone, Morphine).

 

Passive Treatments

Our Glen Iris Physio’s can provide more guidance on whether any of these might be appropriate in your individual circumstance. Some common passive treatments include:

  • Shoe inserts/orthotics
  • Taping and braces
  • Dry needling/acupuncture
  • Manual therapy (massage, joint mobilizations, stretching)
  • Walking aids
  • Hot / cold packs
  • TENS (electrical stimulation)

 

Third Line Treatment

Indicated for severe stage OA and people who have tried not responding to first and second line treatments.

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Surgery

The surgery for OA is joint replacement surgery (Arthroplasty) and generally 80-90% of people have good outcomes. It is important to understand surgery does carry risks (eg. infection), costs and still a long term rehabilitation.

Will an arthroscope delay my need for a knee or hip replacment? No. Guidelines around the world now do NOT recommend arthroscopy (key-hole surgery) for OA, as there is no strong scientific-evidence for its benefit for OA.

 

Other treatment options?

There are numerous other treatments often suggested for OA. How do we know whether we should use these? Thankfully the Royal Australian College of General Practitioners (RACGP) have evaluated the scientific evidence, safety and effectiveness of commonly used interventions for OA. They set out updated guidelines (most recent 2018) to help practitioners make the best current informed decisions on treatment options. Below we summarise some other common treatments for OA and whether they are recommended by RACGP.

Injections

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Cortisone injections

What is it? A steroid injection which targets inflammation

-Shown to offer short-term pain relief, but you should avoid repeated injections.

Synvisc

What is it? Artificial fluid injected to help lubricate the joint

-Potentially shown to offer only small benefits in short term, but is not recommended by RACGP.

Plasma-rich protein (PRP)

What is it? Your own blood is processed and re-injected into the joint.

-Inconclusive evidence that it helps pain for up to 12 months, and needs more research.

Stem-Cell Therapy

What is it? Using the bodies stem cells which have to ability divide and develop different types of cell in the body ie. help grow new tissue.

-Currently NOT recommended by RACGP, due to very low quality evidence and still unknown risks.  There needs to be more high-quality studies before this is considered as a treatment option. 

Supplements

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Glucosamine, Chondroitin, Vitamin D

-None of these supplements are recommended treatments by RACGP.

Turmeric

-Currently inconclusive and still requires more high-level studies before it is recommended as an effective treatment.

 

 

 

References:

We acknowledge The Royal Australian College of General Practitioners (RACGP) Guideline for the Management of Hip and Knee OA 2nd Edition (2018)