Treatment Options for OA

Are there oral and surgical treatment options for OA? Stanley Dysart: There are many non operative treatments for Osteoarthritis and as a practicing orthopedic surgeon I use many of these methods. Our academy has recently looked at arthritis and has looked at the various treatments involved. Acetaminophen is a very common treatment for arthritis. It's readily available, it's over-the-counter, but downside seems to be that it does have a problem with the liver in some individuals. So if you have liver disease, or if you heavily involved with alcohol, you really shouldn't take high doses of Acetaminophen and you should monitor your liver functions but it does work. It's a pain reliever. Jeffrey Rosen: The average person may take two Extra-Strength Tylenol, which is 1000 milligrams. You really shouldn't take more than four doses of two Extra-Strength Tylenol a day or eight tablets. The maximal dose of Tylenol that people should take is eight grams a day. Stanley Dysart: A second course of over-the-counter therapy is nonsteroidals and as you know both ibuprofen and naproxen are over-the-counter medication, they are anti-inflammatories and they can be used successfully between Osteoarthritis. The problem here though is their side effects, there are G.I. side effects, they can cause stomach ulcers, they can cause problems with kidney function, they can also cause problems with the liver. So you have to carefully monitor these medications if they are given at the physician prescribed level. Jeffrey Rosen: The long-term use greater than six weeks has been associated with an increased risk of ulcerative disease in the small bowel. The effects on the cardiovascular system have been called into question and it is thought that anyone who has a history of cardiac history of high blood pressure, cardiovascular disease, history of a coronary artery bypass surgery or a history of a stroke may not be appropriate patient to be taking anti-inflammatory medications. Stanley Dysart: I mean patients on these, patients as you know will purchase many of the over-the-counter medications. They say they're effective, in some studies they seem to be helpful, but what they're doing though I am not so sure. Jeffrey Rosen: Because there are so many side effects associated with taking oral medications, people are much more interested in taking something that is directed at where their problem is. So if you could have a topical medication that delivered an anti-inflammatory effect to the knee-joint because you have a knee problem and avoid the systemic effects of taking the medicine that gets dissolved in your digestive system and then distributed throughout your body, that's a very attractive therapy. So there are increasing interests in localized therapies that would deliver topical anti-inflammatory agents to the joint of interest. Stanley Dysart: I don't think it's modifying the disease. I don't really think it's doing anything with making the knee feel temporarily better. Jeffrey Rosen: Many studies in Europe have demonstrated some beneficial effect of the use of Glucosamine and Chondroitin. In the United States the studies that have recently been completed have not supported their use because it was felt that the effects were not any better than the use of a placebo medication. Stanley Dysart: The NIH, the National Institutes of Health did a large study called the GAIT study and in that study they looked at the effectiveness of Glucosamine and Chondroitin as a treatment for Osteoarthritis and their findings were interesting. They found that it was effective in only a small subset of patients, those who had moderate or severe pain, but in that subset, which encompasses many patients with Osteoarthritis, Glucosamine and Chondroitin sulfate were effective. Jeffrey Rosen: It hasn't been shown that there is any real danger in trying these medications other than the fact that we don't know that there are controlled amounts of the substances of interest in the different preparations. It's recommended that if you are going to try them that you use a well-known company that manufactures the product, one that has a good reputation, and it's again advised that you discuss this with your primary care physician to make sure that there are no contraindications for trying the medications. Stanley Dysart: The side effects of Glucosamine and Condroitin are mainly GI. The dangers are very few. If you're allergic to sulfur compounds though, it's not something you should be taking. Jeffrey Rosen: Very often patients come to the office of a doctor after they have already tried over-the-counter medications that they didn't need a doctor to get and if they failed a number of different over-the-counter medications such as acetaminophen or Aleve or Advil then an appropriate course of action maybe to try a prescription level anti-inflammatory. Again, those patients should not have the cardiac history or a history of cardiovascular disease or stroke, and their blood pressure should be well-regulated and controlled, well they may also not be a candidate for anti-inflammatory medications. Stanley Dysart: COX-2s are widely available for the treatment of osteoarthritis. I use them often. I don't use COX-2 inhibitors as a first-line treatment. I'd rather use other readily available nonsteroidals or acetaminophen, but if those are failed, or if they're ineffective, I will use a COX-2 inhibitor. Jeffrey Rosen: The end result of osteoarthritis is an arthritic knee that has no cartilage left to cushion the joint. And the end stage treatment for end-stage arthritis is knee-replacement surgery. Stanley Dysart: If a patient has failed HA therapy or if a patient has tried Hyaluronic injections and they would like to proceed to arthritis surgery, that's certainly a possibility, but not every patient chooses to do so, some patients will have repeat series, or some patients will choose to continue with their current treatment regimen for a long period of time. Jeffrey Rosen: Knee replacement surgery is not a small undertaking. It is a procedure which involves a hospitalization stay from three to five days. It is also a process that will take about three months to recover to about 80% of normal. However, if a patient is at the point where they are non-ambulatory and they can't function because of daily pain in their knees, then it is important for them to discuss the possibility of knee replacement surgery as a possible treatment option. Stanley Dysart: Knee replacement is one of the most successful operations that orthopedic surgeons perform. Routinely there are 90% or greater good or excellent results. So it's a very good operation at the right time and to the right patient.