Treatment of Osteoarthritis

Dr. Norman B. Gaylis

I talked about osteoarthritis in my last article, how it presents itself and how it is the most common form of arthritis affecting 25 to 30 million Americans. In fact, 14 million Americans alone suffer from osteoarthritis of the knee. There have been some major breakthroughs in the medical treatment of osteoarthritis in the last few years. I would like to discuss the most common forms of treatments used today but certainly not all of the types of treatments.

Aspirin-like anti-inflammatory drugs, the so called nonsteroidal anti-inflammatory drugs, were the most commonly used drugs to treat osteoarthritis for many years. Unfortunately, while they were effective, they had a very high incidence of gastrointestinal side effects including peptic ulceration and bleeding. We are very fortunate in that, in the last few years, we have had a new group of (rugs developed, the so called COX-2 specific inhibitors. This group of drugs, which includes Celebrex and Vioxx, is able to provide the same anti-inflammatory benefits of the older group of drugs without causing as many gastrointestinal side effects.

As we move towards the future, these medications are going to be progressively refined to become more effective and more tolerable. It is my, belief that, at this point it time as we enter a new millennium, there is no reason not to use this new COX-2 grout of anti-inflammatory drugs as the basis of medical therapy for osteoarthritis.

There are a number of over the counter medications available for the treatment of arthritis. Caution should be exercised in treating oneself because the use of over-the counter anti-inflammatory drugs is fraught with potential problems, in particular, because of the side effects that these drugs can cause. I would urge all of you thinking about treating yourselves, to please speak to your physician before going tout and buying an over-the-counter medication which, when taken in accumulative dosages, can be extremely toxic. My personal thought is that the availability of these drugs over the counter does the patient population a disservice because of the high number of side effects that occur when these drugs are taken in an uncontrolled situation.

I should also mention the use of chondroitin sulfate and glucosamine as one of the most recently touted breakthroughs in the treatment of osteoarthritis. There is some marginal anti-inflammatory benefit and improvement of symptoms in patients with osteoarthritis who use these substances. It seems in the early cases of osteoarthritis where the pain and stiffness have just developed in the joints, the use of chondroitin sulfate and glucosamine may have a beneficial effect in reducing discomfort as well as in prevention further progression of the disease. However, in the majority of cases, the improvement is minimal and does not really benefit the more advanced cases of osteoarthritis.

For all of the above therapies to work, the patient needs to have in sight into the cause of their problems. For example, if there is osteoarthritis of the hip or the knee, walking may be aggravating the problem in their joints and, therefore, should be avoided. Likewise, any aggravating factor that may affect the involved joints in a negative way needs to be reversed or discontinued to allow for the best outcomes. Also, patients who have a weight problem will certainly cause stress to their weight bearing joints over the period of a life time and, therefore, treating arthritis in the knees and the hips involves getting the patient to try and keep their weight at an acceptable level for themselves.

In conclusion, osteoarthritis is a very treatable and, at times, preventable disorder. If anyone has pain, stiffness or swelling of any of their joints, please see your physician as soon as possible as the longer it takes to be treated, the more difficult it is to have a positive outcome.