Treatment Options for Osteoarthritis

1. Treatment Options for Osteoarthritis Adam Bastin Prof. Powdrill March 27, 2008

2. Rheumatoid Arthritis Autoimmune Symmetrical Joint pain, swelling, stiffness, fatigue Better once joint is used Osteoarthritis Asymmetrical Joint pain, stiffness Pain is worse with use Boney enlargement Weight bearing joints Joint space narrowing Arthritis

3. Osteoarthritis • Most common joint disorder worldwide • Diagnosed on clinical presentation and supported by radiography. • Risk Factors • Older age, female sex, obesity, trauma, quadriceps weakness, and nutritional deficiencies

4. Osteoarthritis

5. Osteoarthritis Measurement Scales • Western Ontario and McMaster Osteoarthritis Index (WOMAC) • Questionnaire with twenty four questions about pain, function, and stiffness • Visual Analogue Scale • 100 mm long line with descriptive words (no pain / worst pain ever felt) on either side • Lequesne Index • Questionnaire 11 questions that ask about the patient’s symptoms and functional ability

6. Review of Literature • Exercise Related Therapy • Pharmaceutical therapy • Various procedures performed to relieve symptoms

7. Exercise Therapy • Indicated for mild to moderate osteoarthritis • Water therapy – Very effective • Good for elderly patients • Exercise training – Effective • Improvements in both knee and hip patients • Weight loss – Effective • Weight loss groups improved over weight stable group (All studies had statistically significant results on the scales discussed earlier)

8. Pharmaceutical therapy • Indicated for mild, moderate, and severe • NSAIDS – Very common • Transdermal Fentanyl • Indicated when NSAIDS, weak opiods don’t work • Glucosamine • Improves repair process and formation of cartilage (All studies had statistically significant results on the scales discussed earlier)

9. Various Procedures • Hyaluronic acids • Injected into the joint capsule to reduce friction and improves articulation (act as synovial fluid)

10. Various Procedures • Joint Replacement Surgery • Improved pain and overall patient well being

11. Various Procedures • Acupuncture • No difference seen in patients who exercised and advice when compared to patients who exercised, had advice, and acupuncture.

12. Treatment Overview

13. Conclusion • Treatment is different with every individual • Think about severity of osteoarthritis symptoms when considering treatment options • Consider patients goal for treatment (pain free vs. being able to perform activities)

14. References • Arthritis Foundation, Disease Center: Osteoarthritis, Available at: http://ww2.arthritis.org/conditions/DiseaseCenter/OA/oa_epidemiology.asp, November 23, 2007 • Cochrane T, Davey RC, Matthes Edwards SM. Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Health Technology Assessment. 2005 Aug; 9(31). • Dawson J, Linsell L, Doll H, Zondervan K, Rose P, et al. Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population. Osteoarthritis and Cartilage. 2005; 13(10): 854-60. • de Jong ORW, Hopman-Rock M, Tak ECPM, Klazinga NS. An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip. Health Education Research. 2004; 19(3): 316-25. • Foster NE, Thomas E, Barlas P, Hill JC, Young J, Mason E, et al. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ. 2007; 335: 436-48; originally published online 15 Aug 2007. • Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient-specific gait modifications for knee osteoarthritis rehabilitation. IEEE Transactions on Biomedical Engineering. 2007 Sep; 54(9): 1687-95. • Gould D, Kelly D, Goldstone L, Gammon J. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. Journal of Clinical Nursing. 2001; 10:697-706. • Hunter DJ, Felson DT. Osteoarthritis. BMJ.2006 Mar; 18(332): 639-42. • Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003; 62: 1145–55. • Juni P, Reichenbach S,Trelle S, Tschannen B, Wandel S, Jordi B, et al. Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee. Arthritis & Rheumatism. 2007 Nov; 56(11): 3610-19. • Langford R, McKenna F, Ratcliffe S, Vojtassa´k J, Richarz U. Transdermal Fentanyl for Improvement of Pain and Functioning in Osteoarthritis: A Randomized, Placebo-Controlled Trial. Arthritis & Rheumatism. 2006 Jun; 54(6): 1829-37. • Loyd M, Rublee D, Jacobs P. An economic model of long-term use of celecoxib in patients with • osteoarthritis. BMC Gastroenterology. 2007; 7(25). • Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Land KA.Effects of Strength Training on the Incidence and Progression of Knee Osteoarthritis. Arthritis & Rheumatism (Arthritis Care & Research). 2006 Oct 15; 55(5): 690-99. • Miller GD, Nicklas BJ, Davis C, Loeser RF, Lenchik L, Messier SP. Intensive Weight Loss Program Improves Physical Function in Older Obese Adults with Knee Osteoarthritis. Obesity. 2006 Jul; 14(7): 1219-30. • Orthoteers Organization, WOMAC, Available at: http://www.orthoteers.org/(S(qmyfg0ribj51evba5wm1y1z2))/content/contentnoframeset.aspx?article=367&c=1, February 16, 2008 • Reginster JY, Bruyere O, Fraikin G, Henrotin Y. Current Concepts in the Therapeutic Management of Osteoarthritis with Glucosamine. Bulletin of the Hospital for Joint Diseases. 2005; 63(1&2): 31-36. • Rowe, PJ, Myles CM, Nutton R. The effect of total knee arthroplasty on joint movement during functional activities and joint range of motion with particular regard to higher flexion users. Journal of Orthopaedic Surgery. 2005; 13(2): 131-138. • Google images