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Non-Operative Management of Arthritis with Dr. Ronald Hillock- Part Two

Ronald W. Hillock, M.D.

If you or a loved one has been diagnosed with osteoarthritis of the knee or hip (or both) there are several non-operative medical treatment options that should be used before considering surgery. These options are weight loss, medications, exercise through physical therapy, injections, alternative medicine in the treatment of osteoarthritis, and bracing and foot wear.

Osteoarthritis is one of the most common conditions I am asked to evaluate and treat. It is estimated that 27 million Americans are currently living with the pain of osteoarthritis. Patients seeking treatment for the arthritis represent about 25% of all visits to primary care clinics1. Globally there are about 250 million who live with the daily pain of Osteoarthritis (OA), which is roughly 3.6% of the world’s population2.

Non-Operative Management Option 2: Medications

Acetaminophen

Acetaminophen has long been known to be first line therapy in the treatment of osteoarthritis. 4, 5 This drug is an over the counter medication marketed under the trade name Tylenol® in the United States. I would caution anyone using this medication to avoid alcohol within 12 hours of ingestion to protect liver function and serious side effects. Acetaminophen can be taken concurrently with NSAIDs without drug drug interaction or fear of side effects.

NSAIDs (non steroidal anti-inflammatory drugs)

This is a class of medication that is either taken by mouth or applied to the skin in a topical ointment or gel. It is considered the first line of therapy for arthritis related pain. NSAIDs require monitoring to insure the recipient is not experiencing subtle complications that are only detectable through blood testing. These medications are considered the standard of care and should be used for the treatment of arthritis unless you have a proven allergy or you cannot tolerate the side effects. A small percentage of patients can not tolerate these medications due to gastric distress or stomach pains. An even smaller percentage of patients, develop gastric ulcers and bleeding while taking these medications. NSAIDs are best managed by your primary care provider.

Capsaicin

Capsaicin is a topical ointment made from the ingredient that makes cayenne peppers spice and hot. This has been reported to reduce the pain of arthritis but the effect is not consistant and therefore not standard therapy any longer.

Antidepressants

Antidepressants have recently been advocated for the management of chronic pain with or without depression. Since 2010, the Food and Drug Administration has approved the use of Cymbalta® for the treatment of musculoskeletal pain including Osteoarthritis.

Learn more about treating arthritis or would like an appointment with Dr. Hillock.


References

1. “Table 9: Estimated prevalence of moderate and severe disability (millions) for leading disabling conditions by age, for high-income and low- and middle-income countries, 2004”The Global Burden of Disease: 2004 Update. Geneva: World Health Organization. 2008. p. 35.

2. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M et al. (December 2012). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet 380(9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2PMID23245607

4. Flood J (March 2010). “The role of acetaminophen in the treatment of osteoarthritis”Am J Manag Care 16 (Suppl Management): S48–54. PMID20297877

5. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (September 2007). “OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence”. Osteoarthr. Cartil. 15 (9): 981–1000. doi:10.1016/j.joca.2007.06.014PMID17719803

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