Arthritis treatment options

The treatment options covered in this article relate to osteoarthritis, although many of them may be effective rheumatoid arthritis treatments. Please ask your physician before starting any treatment.

Many patients with bone and joint pain assume they have arthritis. There are numerous causes of joint pain, which are not related to arthritis. Always get a proper diagnosis before attempting self-treatment. A physician trained in the management of arthritis will evaluate your condition, give you a diagnosis, and develop a treatment plan.

Start an exercise program

Exercise is an integral part of treating arthritis. Exercise by itself will not wear out your joints. Activities such as walking, swimming, or gardening can assist in keeping your bones strong and your joints limber. Always consult your physician before starting any exercise program.

Strengthening

Joint swelling and pain can make muscles weak, which is a problem with arthritis. Strong muscles help absorb shock, support joints, and protect you from injuries. Weak muscles in the legs are linked with increased disability from osteoarthritis.

Research has also shown that strengthening exercises in the hip, knee and ankle lead to improved balance and independence. Your physician and physical therapist can help you develop a strengthening program, if appropriate.

Stretching

Flexibility is necessary for comfortable movement during exercise and daily activities. Joint motion also helps lubricate your joints and nourish your cartilage. Generally, stretching is tolerated on a daily basis and is an excellent form of relaxation. Your physician can help you develop a stretching program, if appropriate.

Aquatic therapy

Aquatic therapy is an excellent form of exercise for people managing arthritis and pain. The water's buoyancy protects your joints from impact injury. The water also resists movement, which is helpful for strengthening. Ask your doctor for information on aquatic classes near you.

Walking

Walking is an excellent endurance exercise for almost anyone, including those with arthritis. Check with your physician to obtain any precautions or guidelines.

How much exercise is too much?

If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue, or continuing pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning your program or have changed exercises. Joint pain should not last more than several hours after exercise.

Getting started

Seek help from a healthcare professional to assist you in setting up an individualized program.

Make a plan! Write it down! Set goals!

Exercise at the same time each day so it becomes part of your routine.

Find an exercise "buddy."

Look for an appropriate exercise class.

Stay in the habit of doing some exercise each day. On days when you have more pain, make an effort even if you just do some gentle stretching.

Vary your exercise routine; rotate your exercises.

Evaluate your progress and enjoy your success.

Activity modifications

Body Mechanics

Proper body mechanics can lead to a more effective use of your body and less strain on your joints. The following activity modification guidelines may prove helpful:

Avoid stooping; stand up straight

Avoid sitting in low chairs to reduce stress on your knees and hips when sitting and rising.

While traveling, get up and move around every hour or so to avoid stiff joints.

Avoid impact-loading activities (e.g. running, jumping).

Reduce climbing (e.g. stairs, hills, etc.).

Helpful hints:

If sitting in a chair hurts your back, position yourself as follows. Select a chair that has a firm seat and fairly straight back. Beware of deep, soft chairs or sofas and change positions frequently.

Weight Control

Maintaining your ideal body weight will help keep your joints healthy. Being overweight puts more stress on your weight-bearing joints, making your arthritic symptoms worse and leading to stiffness and pain. Many claims have been made concerning diet as a cause of osteoarthritis but none have yet been proven. Ask your doctor to advise you on a weight-loss program to fit your needs.

Heat / Cold

Heat or cold treatments may be used to decrease pain and increase flexibility.

Cold treatments decrease blood flow and help relieve severe joint pain and swelling.

Heat treatments increase blood flow and help relax muscles.

Heat cold

Use prior to activity Use after exercise

Increases local circulation Decreases local circulation

Improves motion Decreases swelling

Decreases joint ache Better for pain

Helps you relax Reduces inflammation

Nutritional supplements

Recently, nutritional supplements have become a popular for patients with arthritis. Glucosamine and Chondroitin have the most medical support. Veterinarians to treat animals with arthritis first used these supplements.

Glucosamine is a natural building block found in cartilage. Supplemental Glucosamine is produced by extracting it from the shells of crabs and shrimp. Studies have shown it to be useful in reducing pain, especially with arthritis of the hands. Reports of it rebuilding cartilage have been exaggerated. The National Institutes of Health are presently studying glucosamine. Patients with shellfish allergies may be allergic.

Chondroitin Sulfate is commonly taken in conjunction with glucosamine. It is found in cartilage and absorbs fluid. This fluid makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.

Vitamins C and D -Some studies have indicated that patients low in Vitamin C and D may have a higher incidence of arthritis.

Orthotics/ Bracing/ Self-Help Devices/ Support

Simple everyday tasks may be hard to accomplish when your joints hurt. The self-help devices listed below will help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

Orthotics to improve foot alignment

Braces for knee support

Wrist and Hand Splints for rest

Jar openers

Button threaders

Large grips for pencils, garden tools or other hand-held objects.

Abdominal supports to reduce stress on the back

Long-handled reachers or grabbers to help you pick things up without bending

Sock sliders to help you put on socks

Canes, Walkers or Crutches reduce stress across the joints

Control pain

Over the Counter Medications

Medications are important in the treatment of arthritis. They help relieve joint swelling and pain, which can lead to improvement in everyday function and quality of life. All medications have potential side effects therefore should be taken only when necessary.

Acetaminophen

The non-narcotic analgesic Tylenol® is generally safe and effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first line in treatment of arthritis. Tylenol, however, does not reduce the inflammation caused by arthritis. Patients with liver disease should avoid Tylenol. Ask your physician about dosing and safety.

NSAIDs

Non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin®, Advil®, and Aleve® may be suggested by your surgeon. These are very low dose and are usually indicated for mild arthritis pain and may be effective when Tylenol® is not.

Topical Creams

Many topical creams are on the market to reduce pain from arthritis. The American College of Rheumatology does recommend capsaicin as part of the treatment plan. Capsaicin is found in red peppers and is thought to help with the release of the body's natural painkillers while also blocking a chemical that transmits pain signals. Check with your physician before using the cream.

Injections

Your doctor may prescribe injections into your joints to help reduce swelling and pain.

Cortisone injections directly into joints may be used. Cortisone is a naturally occurring hormone produced by the adrenal gland that regulates inflammation. and when injected into a joint can relieve or reduce both swelling and pain. Cortisone may have some negative effects on both joints and soft tissues therefore its use is normally limited to a few injections per year.

Hyaluronate injections have been approved for arthritis of the knee. They may help relieve osteoarthritis pain and restore joint function. Hyaluronate is a naturally occurring substance in joint fluid that provides lubrication and cushioning to the joint.

As osteoarthritis continues to develop, the joint fluid becomes thinner with less hyaluronate and thus loses its ability to properly lubricate and cushion the joint cartilage. Please speak to your doctor about this particular treatment option.

Surgeons who specialize in arthritis can provide you with all the options and expertise to decide whether surgery is right for you.

Knee Surgery Options

Arthroscopy

Arthroscopy uses tiny instruments inserted into the joint through small punctures. Damaged tissue can be removed or repaired within the joint providing relief from both pain and swelling while possibly preventing further damage to the knee.

Total joint replacement- replacing the cartilage

Your surgeon may recommend joint replacement surgery if you have significant arthritis. Surgeons don't actually replace the joint as is commonly thought. Your surgeon actually replaces the damaged cartilage found at the ends of the bones in your knee joint. Perhaps it should be called "cartilage replacement surgery."

Joint replacement implants to resurface the joint are typically made from metal alloy and polyethylene (plastic). The implants are designed to restore function and eliminate as much discomfort as possible while allowing you to return to a more active lifestyle.

Rehabilitation and walking begin the day after surgery, and the hospital stay is normally 3 to 4 days. Therapy will begin in the hospital and usually continues after discharge for approximately 6 to 12 weeks.

Joint Replacement surgery of the knee has been extremely successful in helping patients with arthritis return to their normal activities and relieve their discomfort.

Partial knee replacement

The knee is composed of three separate compartments. Osteoarthritis sometimes develops in only one compartment of the knee, while the other two compartments remain relatively healthy. Patients who have osteoarthritis in only one compartment may be candidates for partial knee replacement.

The advantage of a partial knee is that it resurfaces only the damaged cartilage of the knee, preserving the undamaged cartilage. The benefits of this procedure include a smaller incision (3,4 inches), a quicker recovery, and less bone removal.

The disadvantages are that partial knee surgery may not last as long as total joint replacement surgery. You and your surgeon will determine if a partial knee is appropriate for you.

Rebuilding cartilage

In some patients, a pothole occurs in the joint cartilage on the end of the bone. Various methods may be used to try to correct this problem. The following methods are used primarily for young patients with moderate or isolated cartilage injury.

Microfracture arthroplasty

Microfracture arthroplasty uses an arthroscope to drill small holes into the exposed bone. The holes are designed to encourage cartilage to grow. This procedure is reserved for small areas of

damage.

Direct cartilage transplantation

Direct cartilage transportation takes healthy cartilage and moves it to a damaged area of cartilage. This procedure is reserved for younger patients with small defects, not for patients with significant arthritis.

Growing cartilage

Cartilage cells can be harvested during an arthroscopic procedure and then grown in a lab for later transplantation. These cells are then implanted into the defect. Again, this procedure is reserved for younger patients with small defects, not for patients with significant arthritis.

Hip surgery options

Total hip replacement

When non-operative treatment fails to control the discomfort and stiffness from arthritis of the hip, your surgeon may recommend total hip replacement. Joint replacement implants, typically made from metal alloy and polyethylene (plastic), are used to resurface the joint.

Newer implants with metal sockets are now being used in selective patients. Total hip replacement replaces the upper end of the femur (thighbone) and resurfaces the acetabulum (socket).

The implants are designed to restore function and eliminate as much discomfort as possible while allowing you to return to a more active lifestyle.

Rehabilitation and walking begin the day after surgery, and your hospital stay is normally 3 to 4 days.

Therapy will begin in the hospital and usually continues after discharge for approximately six to twelve weeks. Joint replacement surgery of the hip has been extremely successful in helping patients with arthritis return to their normal activities and relieve their discomfort.

Shoulder surgery options

Arthroscopy

Arthroscopy uses tiny instruments inserted into the joint through small punctures. Damaged tissue can be removed or repaired within the joint providing relief from both pain and swelling while possibly preventing further damage to the knee.

Total shoulder replacement

Arthritis of the shoulder that results in pain and stiffness

may necessitate a shoulder replacement.

The ball end of the shoulder is replaced with a metal ball. The socket may or may not be resurfaced with plastic. The typical hospital stay is 1 to 2 days. Therapy usually continues for 3 months or more.

Ankle surgery options

Arthritis of the ankle can be quite painful. Two options exist for the ankle: fusion and total ankle replacement. Ankle fusion makes the ankle immobile and total ankle replacement uses tiny implants to resurface the damaged cartilage.

Hands/Wrist/Elbow

These joints can often be treated without surgery. However, in some cases either fusion or replacement is performed.

Closing

We know that arthritis can sometimes make life difficult. We hope this has helped you understand some of the basics of treatment so that you understand your doctor's recommendations. Millions of people suffer from arthritis, but there are numerous organizations committed to helping you live better with your condition.

This information is not intended to replace the experience and counsel of your orthopedic surgeon. If you have any further questions, please speak with your orthopedic surgeon.

 

Arthritis treatment options

The treatment options covered in this article relate to osteoarthritis, although many of them may be effective rheumatoid arthritis treatments. Please ask your physician before starting any treatment. Many patients with bone and joint pain assume they have arthritis. There are numerous causes of joint pain, which are not related to arthritis. Always get a proper diagnosis before attempting self-treatment. A physician trained in the management of arthritis will evaluate your condition, give you a diagnosis, and develop a treatment plan. Start an exercise program Exercise is an integral part of treating arthritis. Exercise by itself will not wear out your joints. Activities such as walking, swimming, or gardening can assist in keeping your bones strong and your joints limber. Always consult your physician before starting any exercise program. Strengthening Joint swelling and pain can make muscles weak, which is a problem with arthritis. Strong muscles help absorb shock, support joints, and protect you from injuries. Weak muscles in the legs are linked with increased disability from osteoarthritis. Research has also shown that strengthening exercises in the hip, knee and ankle lead to improved balance and independence. Your physician and physical therapist can help you develop a strengthening program, if appropriate. Stretching Flexibility is necessary for comfortable movement during exercise and daily activities. Joint motion also helps lubricate your joints and nourish your cartilage. Generally, stretching is tolerated on a daily basis and is an excellent form of relaxation. Your physician can help you develop a stretching program, if appropriate. Aquatic therapy Aquatic therapy is an excellent form of exercise for people managing arthritis and pain. The waters buoyancy protects your joints from impact injury. The water also resists movement, which is helpful for strengthening. Ask your doctor for information on aquatic classes near you. Walking Walking is an excellent endurance exercise for almost anyone, including those with arthritis. Check with your physician to obtain any precautions or guidelines. How much exercise is too much? If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue, or continuing pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning your program or have changed exercises. Joint pain should not last more than several hours after exercise. Getting started Seek help from a healthcare professional to assist you in setting up an individualized program. Make a plan! Write it down! Set goals! Exercise at the same time each day so it becomes part of your routine. Find an exercise buddy. Look for an appropriate exercise class. Stay in the habit of doing some exercise each day. On days when you have more pain, make an effort even if you just do some gentle stretching. Vary your exercise routine; rotate your exercises. Evaluate your progress and enjoy your success. Activity modifications Body Mechanics Proper body mechanics can lead to a more effective use of your body and less strain on your joints. The following activity modification guidelines may prove helpful: Avoid stooping; stand up straight Avoid sitting in low chairs to reduce stress on your knees and hips when sitting and rising. While traveling, get up and move around every hour or so to avoid stiff joints. Avoid impact-loading activities (e.g. running, jumping). Reduce climbing (e.g. stairs, hills, etc.). Helpful hints: If sitting in a chair hurts your back, position yourself as follows. Select a chair that has a firm seat and fairly straight back. Beware of deep, soft chairs or sofas and change positions frequently. Weight Control Maintaining your ideal body weight will help keep your joints healthy. Being overweight puts more stress on your weight-bearing joints, making your arthritic symptoms worse and leading to stiffness and pain. Many claims have been made concerning diet as a cause of osteoarthritis but none have yet been proven. Ask your doctor to advise you on a weight-loss program to fit your needs. Heat / Cold Heat or cold treatments may be used to decrease pain and increase flexibility. Cold treatments decrease blood flow and help relieve severe joint pain and swelling. Heat treatments increase blood flow and help relax muscles. Heat cold Use prior to activity Use after exercise Increases local circulation Decreases local circulation Improves motion Decreases swelling Decreases joint ache Better for pain Helps you relax Reduces inflammation Nutritional supplements Recently, nutritional supplements have become a popular for patients with arthritis. Glucosamine and Chondroitin have the most medical support. Veterinarians to treat animals with arthritis first used these supplements. Glucosamine is a natural building block found in cartilage. Supplemental Glucosamine is produced by extracting it from the shells of crabs and shrimp. Studies have shown it to be useful in reducing pain, especially with arthritis of the hands. Reports of it rebuilding cartilage have been exaggerated. The National Institutes of Health are presently studying glucosamine. Patients with shellfish allergies may be allergic. Chondroitin Sulfate is commonly taken in conjunction with glucosamine. It is found in cartilage and absorbs fluid. This fluid makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well. Vitamins C and D -Some studies have indicated that patients low in Vitamin C and D may have a higher incidence of arthritis. Orthotics/ Bracing/ Self-Help Devices/ Support Simple everyday tasks may be hard to accomplish when your joints hurt. The self-help devices listed below will help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices: Orthotics to improve foot alignment Braces for knee support Wrist and Hand Splints for rest Jar openers Button threaders Large grips for pencils, garden tools or other hand-held objects. Abdominal supports to reduce stress on the back Long-handled reachers or grabbers to help you pick things up without bending Sock sliders to help you put on socks Canes, Walkers or Crutches reduce stress across the joints Control pain Over the Counter Medications Medications are important in the treatment of arthritis. They help relieve joint swelling and pain, which can lead to improvement in everyday function and quality of life. All medications have potential side effects therefore should be taken only when necessary. Acetaminophen The non-narcotic analgesic Tylenol is generally safe and effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first line in treatment of arthritis. Tylenol, however, does not reduce the inflammation caused by arthritis. Patients with liver disease should avoid Tylenol. Ask your physician about dosing and safety. NSAIDs Non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil, and Aleve may be suggested by your surgeon. These are very low dose and are usually indicated for mild arthritis pain and may be effective when Tylenol is not. Topical Creams Many topical creams are on the market to reduce pain from arthritis. The American College of Rheumatology does recommend capsaicin as part of the treatment plan. Capsaicin is found in red peppers and is thought to help with the release of the bodys natural painkillers while also blocking a chemical that transmits pain signals. Check with your physician before using the cream. Injections Your doctor may prescribe injections into your joints to help reduce swelling and pain. Cortisone injections directly into joints may be used. Cortisone is a naturally occurring hormone produced by the adrenal gland that regulates inflammation. and when injected into a joint can relieve or reduce both swelling and pain. Cortisone may have some negative effects on both joints and soft tissues therefore its use is normally limited to a few injections per year. Hyaluronate injections have been approved for arthritis of the knee. They may help relieve osteoarthritis pain and restore joint function. Hyaluronate is a naturally occurring substance in joint fluid that provides lubrication and cushioning to the joint. As osteoarthritis continues to develop, the joint fluid becomes thinner with less hyaluronate and thus loses its ability to properly lubricate and cushion the joint cartilage. Please speak to your doctor about this particular treatment option. Surgeons who specialize in arthritis can provide you with all the options and expertise to decide whether surgery is right for you. Knee Surgery Options Arthroscopy Arthroscopy uses tiny instruments inserted into the joint through small punctures. Damaged tissue can be removed or repaired within the joint providing relief from both pain and swelling while possibly preventing further damage to the knee. Total joint replacement- replacing the cartilage Your surgeon may recommend joint replacement surgery if you have significant arthritis. Surgeons dont actually replace the joint as is commonly thought. Your surgeon actually replaces the damaged cartilage found at the ends of the bones in your knee joint. Perhaps it should be called cartilage replacement surgery. Joint replacement implants to resurface the joint are typically made from metal alloy and polyethylene (plastic). The implants are designed to restore function and eliminate as much discomfort as possible while allowing you to return to a more active lifestyle. Rehabilitation and walking begin the day after surgery, and the hospital stay is normally 3 to 4 days. Therapy will begin in the hospital and usually continues after discharge for approximately 6 to 12 weeks. Joint Replacement surgery of the knee has been extremely successful in helping patients with arthritis return to their normal activities and relieve their discomfort. Partial knee replacement The knee is composed of three separate compartments. Osteoarthritis sometimes develops in only one compartment of the knee, while the other two compartments remain relatively healthy. Patients who have osteoarthritis in only one compartment may be candidates for partial knee replacement. The advantage of a partial knee is that it resurfaces only the damaged cartilage of the knee, preserving the undamaged cartilage. The benefits of this procedure include a smaller incision (3,4 inches), a quicker recovery, and less bone removal. The disadvantages are that partial knee surgery may not last as long as total joint replacement surgery. You and your surgeon will determine if a partial knee is appropriate for you. Rebuilding cartilage In some patients, a pothole occurs in the joint cartilage on the end of the bone. Various methods may be used to try to correct this problem. The following methods are used primarily for young patients with moderate or isolated cartilage injury. Microfracture arthroplasty Microfracture arthroplasty uses an arthroscope to drill small holes into the exposed bone. The holes are designed to encourage cartilage to grow. This procedure is reserved for small areas of damage. Direct cartilage transplantation Direct cartilage transportation takes healthy cartilage and moves it to a damaged area of cartilage. This procedure is reserved for younger patients with small defects, not for patients with significant arthritis. Growing cartilage Cartilage cells can be harvested during an arthroscopic procedure and then grown in a lab for later transplantation. These cells are then implanted into the defect. Again, this procedure is reserved for younger patients with small defects, not for patients with significant arthritis. Hip surgery options Total hip replacement When non-operative treatment fails to control the discomfort and stiffness from arthritis of the hip, your surgeon may recommend total hip replacement. Joint replacement implants, typically made from metal alloy and polyethylene (plastic), are used to resurface the joint. Newer implants with metal sockets are now being used in selective patients. Total hip replacement replaces the upper end of the femur (thighbone) and resurfaces the acetabulum (socket). The implants are designed to restore function and eliminate as much discomfort as possible while allowing you to return to a more active lifestyle. Rehabilitation and walking begin the day after surgery, and your hospital stay is normally 3 to 4 days. Therapy will begin in the hospital and usually continues after discharge for approximately six to twelve weeks. Joint replacement surgery of the hip has been extremely successful in helping patients with arthritis return to their normal activities and relieve their discomfort. Shoulder surgery options Arthroscopy Arthroscopy uses tiny instruments inserted into the joint through small punctures. Damaged tissue can be removed or repaired within the joint providing relief from both pain and swelling while possibly preventing further damage to the knee. Total shoulder replacement Arthritis of the shoulder that results in pain and stiffness may necessitate a shoulder replacement. The ball end of the shoulder is replaced with a metal ball. The socket may or may not be resurfaced with plastic. The typical hospital stay is 1 to 2 days. Therapy usually continues for 3 months or more. Ankle surgery options Arthritis of the ankle can be quite painful. Two options exist for the ankle: fusion and total ankle replacement. Ankle fusion makes the ankle immobile and total ankle replacement uses tiny implants to resurface the damaged cartilage. Hands/Wrist/Elbow These joints can often be treated without surgery. However, in some cases either fusion or replacement is performed. Closing We know that arthritis can sometimes make life difficult. We hope this has helped you understand some of the basics of treatment so that you understand your doctors recommendations. Millions of people suffer from arthritis, but there are numerous organizations committed to helping you live better with your condition. This information is not intended to replace the experience and counsel of your orthopedic surgeon. If you have any further questions, please speak with your orthopedic surgeon.