Osteoarthritis

As an Orthopedic surgeon I am daily confronted with new patients who present with joint pain. For many of them it leads to the initial diagnosis of “osteoarthritis”.

So “what is Osteoarthritis?” What does it all mean? How does it affect my life? My activity level? My quality of life?

Am I destined to be a cripple? What caused it?

So here is the real truth! I am often criticized for being “blunt” and “to the point”! That is what you get from me.

Osteoarthritis is either “primary” or “post-traumatic”. We don’t know what causes “primary” osteoarthritis. It just happens. There are genetic factors that contribute to OA. Dietary factors play a part as does weight (obesity). Activity level also plays a role in progression of disease.

Post-traumatic OA is triggered by injury rather than other factors. As an example, if you tear your ACL as a youthful athlete, the likelihood that you will subsequently develop OA in the previously injured knee is upwards of 50%.

Sometimes there is a combination of factors. This would be in an individual who has a strong family history of joints failing prematurely who then is an aggressive athlete who sustains a major knee injury playing soccer or football. The knee is repaired following the injury but then the joint fails much faster than anticipated.

So you have “mild OA” regardless of the cause. What can you do about it?

The goal in managing OA is to do those things which will support the affected joint, reduce the symptoms of pain and swelling, if possible slow progression of the disease or in some cases perhaps reverse the disease process. Of course when making decisions about treatment options one must consider risks, benefits, cost and impact of quality of life.

So here are your options in managing early or mild Osteoarthritis.

Nutritional factors are my starting point. Natural joint supplements are very effective in supporting joint resilience, reducing pain and swelling and in some cases, increasing the thickness or health of the joint cartilage.

Nutritional factors include commonly known Glucosamine and Chondroitin. Too many patients use those products and stop at that level. There are however about a dozen other nutritional elements that are really helpful. Products such as Forté Joint put all of those elements together in a simple delivery model. It includes not only the basics but also several very potent natural anti-inflammatory agents, vitamins and minerals known to be effective in supporting joint health.

OA is a lifetime diagnosis. When making treatment options you must think about the potential side effects of long term use of various medications. The natural agents are safe and without the side effects of many of the pharmaceuticals designed to treat OA.

Weight loss is an important management option if needed. Generally speaking Obesity does not directly cause OA however if you have OA and are overweight and then lose weight your joints will feel better. That make’s sense.

Exercise is important in managing OA but it must be the right exercise. Walking is good and generally not harmful. Running or other high impact exercises may accelerate the pain and swelling. Non impact activities such as light weight training (high repetition with low weight), swimming, biking, yoga and some circuit training can be very effective in maintaining function and reducing pain.

Bracing can be helpful in some circumstances. When OA is localized to one compartment of the knee and “Unloader” brace may reduce the load on the diseased part of the joint. It is kind of like if you have a bad tire on your car and you could somehow adjust that wheel so the rubber tread doesn’t quite hit the asphalt. Obviously it would last longer. That is the rationale behind unloader braces.

NSAID (Non Steroidal Anti Inflammatory Drugs) are what most physicians will prescribe to reduce the symptoms of OA. They include over the counter drugs like Aleve or Advil (ibuprofen). There are a number of prescription drugs as well. A few include Celebrex, Diclofenac, Indocin, Naprosyn just to name a few of the more common drugs. They work but bring with them a series of predictable side effects including ulcers, gastritis, gastric bleeding, kidney damage and liver failure. Over the short term they are relatively safe and effective but remember OA is a lifetime condition. Life time or prolonged use of NSAID’s can be dangerous and, in my practice, is not an options. If your use them use them sparingly.

There is ample evidence that for many patients the natural products are as effective as the prescription drugs but without the side effects.

Injections are often used in managing OA. There are four basic types to consider.

Corticosteroids have been considered the gold standard by many. A cortisone injection into an arthritic knee often reduces pain and the results can be quite dramatic. Long term use of such products ultimately can add further damage to joint cartilage and therefor should be used sparingly especially in younger individuals. On the other hand in the older patient who already is worn down to the bone (bone on bone) such injections can improve quality of life on a short-term basis and avoid the need for surgical intervention. It can also be helpful for the “end stage” knee in the individual who may not be a surgical candidate.

Visco-supplementation includes a number of “jelly-like” injections that contain a protein similar to one found in the comb of a rooster. Yep! In some cases it has been shown to reduce pain and delay the need for major knee replacement surgery. In recent years the efficacy of these drugs has come in to question but they may still be valuable for some. Some insurance companies no longer pay for these injections so check that out before you try these injections.

PRP (Platelet Rich Plasma) is a special product created from you own blood. I draw your blood then spin it down in a specialized centrifuge designed to extract the portion that contains the platelets. The Platelets are little packets containing many very valuable and important proteins useful in healing and recovery. If the PRP is harvested without white cells (Leucocyte poor PRP) it can dramatically reduce pain and swelling in an arthritic joint much like cortisone but without the side effects and potential damage to your joint.

Stem Cell Therapy is the most “exotic” of all treatments. Stem cells obtained from your bone marrow in an “in office” procedure can be specially prepared and injected into the disease or injured joint often with dramatic improvement. The technique is relatively new and insurance companies consider it experimental and won’t pay for it even though it is FDA approved and considered “safe”. It is the most exciting part of my treatment options.

Surgery can include arthroscopy or partial or total Joint replacement. These options are to be considered only if other methods have failed to achieve an acceptable quality of life.

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