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Osteoarthritis
Symptomatic Treatment of Painful Osteoarthritis
a report by
Edward C Huskisson
Consultant Rheumatologist, King Edward VII Hospital
All too often, patients consult doctors because of osteoarthritis and
Table 1: A Selection of Possible Treatment
Options for Osteoarthritis
nothing gets done; they are told that it is just part of the ageing
process, or are simply given paracetamol or perhaps an anti-
NSAIDs Analgesics
inflammatory drug, because a prescription is quicker and easier than
Exercises Topical treatment
advising about the complete package of measures for an individual
Appliances Injections
patient – diet, supplements and exercises. However, in reality Supplements – diet Surgery
osteoarthritis is not just due to ageing joints. It is an active process in
cartilage that begins with monotonous regularity at age 50, is highly simple analgesics, and the combination of paracetamol and
genetic, is accompanied by inflammation – particularly in the early dextropropoxyphene (coproxamol) is often ideal. Quadriceps exercises
stages – and leads to progressive loss of cartilage. are of proven value in relieving knee pain. A walking stick may help to
relieve the pain of a weight-bearing joint and a splint may help a
There are lots of things that can be done to alleviate the symptoms of painful wrist or thumb. Orthotics are useful for osteoarthritis of the big
osteoarthritis, and the aim of treatment is to find the right toe and tarso-metatarsal joints, where pronation is often an important
combination of measures for a particular patient. The goal is to achieve cause. Rubbing is the oldest way of relieving pain and ointments may
the best possible relief of symptoms at the lowest cost, both in terms help. NSAID gels have been shown to be more effective then placebo,
of money and of side effects. which is itself very effective. Gels do not upset the stomach or cause
gastric bleeding.
Osteoarthritis – Background
Osteoarthritis affects about 15% of the population. It is a very common
cause of disability in later life. In primary osteoarthritis, in genetically
predisposed individuals it seems that cartilage is no longer capable of NSAIDs are the mainstay of
repair after the age of 50. The resulting deterioration is accompanied by
symptomatic treatment of
inflammation. Evidence for the importance of inflammation comes from:
osteoarthritis. Many patients simply
• the clinical features of the disease, including pain, morning stiffness
cannot manage without them.
and swollen joints, which are often warm and with effusions;
• synovial histology, which is sometimes difficult to differentiate from
rheumatoid arthritis; and Two types of intra-articular injection can be used in osteoarthritis:
steroids and hyaluronic acid. Steroid injections are very effective for
• the response to anti-inflammatory drugs. some small joints, including:
Women are about three times more likely to be affected than men. • the proximal interphalangeal joints of the hands;
Osteoarthritis usually affects one, two, three or four sites; the knees
are the most commonly affected site, followed by the hands, feet, • the first carpo-metacarpal joints; and
hips, ankles and spine. Trauma or other mechanical factors are
sometimes to blame for osteoarthritis and may explain the localisation • the first metatarsophalangeal joints.
of disease in genetically predisposed individuals. Rarely, a metabolic
problem like haemochromatosis is the cause. Steroid injections will also help in acute exacerbations in the knees
and ankles.
Range of Treatments
Lots of things can be done for patients with osteoarthritis; these are Hyaluronic acid is given as a course of three to five injections, which
summarised in Table 1. It is seldom the case that a tablet is all that provide relief of pain for six months or more.
is needed.
Supplements such as glucosamine and chondroitin are particularly
Apart from non-steroidal anti-inflammatory drugs (NSAIDs), which useful for small-joint disease, but are also worth trying for other
are probably the mainstay of symptomatic treatment, one can use complaints as they produce no side effects. Diet may also be helpful in
© TOUCH BRIEFINGS 2007 25
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