Clinical management of osteoarthritis

Clinical management of osteoarthritis consists of making proper diagnosis and then moving to treatment.

Diagnosis is mainly dependent upon radiographic findings such as Xrays and MRI in addition to clinical symptoms. These findings can only be picked up by a healthcare professional, particularly a radiologist but for increasing overall health awareness, main points are described below.

• First and the most common finding is joint space narrowing due to loss of cartilage.
• Another finding is formation of osteophytes. These are formed by deposition of fibrous cartilage at joint margins.
• Others findings are subchondral sclerosis and cysts but there is no need on the part of patient to know them.
• Sometimes MRI (magnetic resonance imaging) may be necessary before surgery.
• All the blood tests are normal in osteoarthritis. If abnormal, these may be due to some other disease.

Treatment of osteoarthritis:

Before treatment it is important to note that the joint damage that has occurred already cannot be reversed. The treatment goals in osteoarthritis are mainly alleviation of pain and improving functional status of patient.

Treatment consists of pharmacologic therapy in which we use certain pain killers for reduction of pain and also non pharmacologic therapy which consists of changes in lifestyle and some home remedies.

Pharmacologic Therapy:

For mild to moderate symptoms, acetaminophen is the first line agent. If the clinical response is unsatisfactory, you can use nonsteroidal anti-inflammatory drug (NSAID). Initially, lowest effective dose should be used.

If the symptoms are not well controlled, then full doses can be tried. The main problem with using NSAIDs is that these are harmful for our stomach and kidneys. These drugs damage inner protective layer of stomach (mucosa) and then the acid in stomach has got chance to cause more damage. To prevent this side effect some Pharmaceutical companies have added prostaglandins such as misoprostol to their formulations. These prostaglandins have protective role for stomach mucosa. But it is important to note that drugs containing misoprostol cannot be used for pregnant women because it can cause abortion. For pregnant women, you can try antacids and anti-secretory drugs such as omeprazole which lower the production of acid in your stomach. Sometimes a special groups of NSAIDs called COX-2 inhibitors can also be used but consultation with a healthcare professional is necessary because these agents may be harmful for your heart and blood vessels and are rarely used.

Topical formulations of NSAIDs are also applied can be applied to skin over the affected joints. Some commonly available NSAIDs are mentioned below:

• Diclofenac
• Ibuprofen
• Flurbiprofen
• Ketorolac

Besides these painkillers, opioids can be given to patients suffering from severe disease and also to those patients who are unable to tolerate these drugs due to gastrointestinal, kidney or heart problems. These common pain killer should also be used with caution if you are suffering from asthma or you have allergy to aspirin or its products.

Sometimes your doctor can prescribe you antidepressants such as duloxetine which has role is alleviating pain of osteoarthritis. Other options are steroid injections inside your joint and joint replacement therapy.

Non Pharmacologic options and home remedies:

• Avoid activities which require excessive us of joint.
• Weight loss is very important. By losing excessive weight you are reducing risk factor. You may consult with your nutritionist and ask for for a proper diet plan according to your age and overall health
• Physical therapy is very beneficial for patients of osteoarthritis. The main goal is to maintain range of motion and muscle strength. Swimming is an Ideal exercise for this purpose (involves minimal involvement of weight bearing joints.
• Applying heat to affected joints is also beneficial. you can use hot blanket and you can take shower with warm water. This heat blocks pain pathways going to your central nervous system. Same effect can be achieved by applying cold ice packs to the affected joints.
• Some topical creams and gels also contain agents which produce heat and are soothing for pain and are easily available in market.
• Acupuncture is an ancient Chinese technique for pain relief and has no side effects.
• Some foods which contain omega-3 fatty acids are also beneficial for alleviating pain of osteoarthritis.
• Yoga, meditation and reducing mental stress have much role in managing pain of osteoarthritis. Sometimes your doctor can prescribe you anxiolytics for this purpose.
• Massage can be done at home and touch sensations particularly form your loved ones reduce transmission of pain signals to your brain.
• The list for home remedies is exhaustive and the above options are most beneficial according to present day medical research.