Do You Know Your Options For Osteoarthritis?
If you have osteoarthritis, ask your doctor about changing treatment options every once in a while. Here’s why.
By: Scott Burg, DO
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“What are my options?”
If you have a persistent condition such as osteoarthritis, ask this question frequently. When you have a health issue that goes on for years, it’s easy to just go about your regular treatment routine and assume it’s still the best. But it never hurts to ask for new options and the latest information about what’s happening in the field.
There is no cure for osteoarthritis. But the way we manage the disease and offer relief from symptoms continues to improve. Below are just a few examples.
Is your impression of knee braces based on flimsy over-the-counter options? Then it’s worth having a talk with your doctor.
Specialists can design very light, very portable knee braces based on exactly where your knee is damaged. These braces aren’t just for support, though. For example, one option is an “unloader” brace, which releases the stress and physical pressure on your joints. Your knee pain comes from bone-on-bone friction. These braces create a gap to prevent that friction. After damaging my own knee skiing several years back, I use one myself.
Best of all, a good brace may allow you to keep exercising. Exercise not only helps you keep your range of motion, but also maintain a healthy weight. And being overweight is one of many risk factors for osteoarthritis.
New medications for treating osteoarthritis are few and far between. That may be partially because of the risks associated with non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly used to treat the pain and inflammation of osteoarthritis. Long-term NSAID usage may have risks for your kidneys, liver and cardiovascular system.
There have been some changes in recent years, though. For example, the antidepressant duloxetine hydrochloride (Cymbalta) was approved by the FDA in 2010 to treat the pain of osteoarthritis, such as lower back pain. That has been a big help for people who can’t tolerate NSAIDs or other treatments.
Researchers are comparing and contrasting current options, too. A recent comparative analysis found that hyaluronic acid injections in the knees offer more relief to patients than NSAIDs and other options, for example. This treatment is called viscosupplementation.
Hyaluronic acid occurs naturally in your joints. The basic idea is that injections reduce inflammation and lubricate the joint. Study results have been mixed in some cases, and doctors can’t always predict who will respond best. But for patients who respond well, a doctor can offer injections every six months with limited concerns about side effects.
In the same analysis, cortisone injections performed well, too. There’s little doubt they offer relief. But cortisone also comes with the risk of thinning your cartilage over time. Doctors view long-term use cautiously. That’s why many recommend hyaluronic acid as an alternative. However, it is only available as a treatment for knees at present.
“Everything must go” is no longer a given when it comes to joint surgeries and procedures.
Birmingham hip resurfacing is a great example. Rather than replacing the whole hip joint, surgeons shave and “cap” a portion of the hip to prevent the friction that causes so much pain. The procedure comes with shorter rehab time — especially important for younger, more athletic patients who want to get back to being active quickly. It also does not prevent a total replacement later if needed.
Partial knee replacements help a small percentage of patients, too. For example, if your symptoms are in the medial compartment — the very inside part of the knee joint — but the outside parts of your knee are in pretty good shape, you may be a candidate. Like hip resurfacing, a partial knee replacement comes with a shorter rehab and keeps your options open for a full replacement in the future.
In the long run, some patients will still need total joint replacements. But more and more patients are finding that they have conservative options that come first.