What are the treatment options available for arthritis?
Your doctor has told you that you suffer from arthritis. Its not the end of the world. Modern medicine has several options to bring the associated pain under control and give you long term relief. In this short write-up I will take you through the various options available. If you want to know more about arthritis and its causes, it will help you to go through the article on arthritis I wrote some time back.
Early versus advanced arthritis
For easy understanding, I will divide patients into these broad groups. The treatment options vary based on the degree of arthritis affecting your joint. Early arthritic changes can be treated very well with medications, exercises, braces and physiotherapy, including a few home remedies. Advanced stages, unfortunately do not respond very well to these treatments, and the only way out often is surgery.
Plenty of options exist for those who suffer from rheumatoid arthritis. Anti-inflammatory agents are used to suppress the inflammation of the synovial lining. Immunomodulators are also used to control disease activity. Often when sever, your doctor may also prescribe steroids and stronger immune response suppressing medications like methotrexate. Rheumatoid arthritis can be disabling, as the progressive disease often destroys the cartilage lining of the joints early in life. Do consult a good rheumatologist or ortho surgeon to get the right dose of medicines. You also need to understand that treatment with medicines is a long drawn process, and often your doctor has to alter the medicines or their dosages. A lot of medicines have side effects as well but with patience and co-operation, most patients are able to lead comfortable lives.
Osteoarthritis on the other hand, can only be treated with anti-inflammatory medicines. Although there are plenty of cartilage vitamins, none have proven to work. There is an important reason for this. Cartilage tissue, unlike other tissues in the body cannot heal itself. Hence supplying cartilage vitamins don't work. Some patients do claim relief, and that's reason for many doctors to continue prescribing them. I don't believe that they work, so I don't prescribe them. Gouty arthritis too responds well to medicines.
I am not going into the details, as I do not want you to self-medicate. Medicines are best obtained in discussion with your doctor.
Exercising is an important way to prevent the arthritis joints from becoming stiff. Putting the joint through its range of motion, helps to keep it supple and prevents further deteioration. The best exercises for your joints are non-impact exercises like swimming and cycling or low impact exercises like walking. Running, especially on hard surfaces like a treadmill is best avoided. Strengthening exercises for the muscles acting on the joint helps you to overcome pain and maintain an active joint.
Braces are used as external appliances to support the joint and prevent deformities from occurring. They work best in cases of osteoarthritis of the knee joint. Braces can help unload the joint and prevent further progression of damage to the cartilage. At times, bracing the fingers or the wrist can help rest the joint when severely affected by rheumatoid arthritis. Hip arthritis is usually not treated by braces.
If anti-inflammatories do not provide sustained relief from pain, a cortisone injection into the joint can help sustain relief from pain for a long time. Cortisone (steroid) is a potent anti-inflammatory medicine. I employ it often for arthritis affecting the hip, knee and ankle joints. There are also viscous supplements available. These agents are known to work best in case of the knee joints. A viscous fluid, similiar to the naturally occurring synovial fluid, is injected into the joint. I have used it in several patients, and in cases of early osteoarthrits, it often provides relief from pain for several months. However the evidence in favour of this treatment is not very strong.
When the pain is constant and starts interfering with your daily routine, it is time to consider surgery. Total hip replacement for the hip, total knee replacement for the knee joint and shoulder replacement surgeries can provide lasting relief from pain. Surgeries can also correct any pre-existent deformities leading to a stable and functional leg. Advances in biomaterials has meant that joint surfaces are long lasting and resistant to wear unlike the ones used decades ago. With the availability of fourth generation ceramic joints (delta ceramics), patients are often able to return to an active and functional life. Personally I do not hesistate to recomment joint replacement patients even if they are young, because it is when they are younf that they need to be active. There is no point in suffering in pain when excellent surgical options are available today.
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