Arthritis Treatment: Conventional Approach to Osteoarthritis Treatment

Osteoarthritis (OA) is, without question, the most common form of arthritis. It is a disease of articular cartilage, the gristle that caps the ends of long bones. Cartilage consists of a mixture of proteins and sugars (proteoglycans), and collagen. Interspersed in this matrix of substances are chondrocytes, cartilage cells. The purpose of the chondrocytes is to manufacture new healthy matrix and keep it healthy.

With the onset of OA, the chondrocytes begin to elaborate destructive enzymes. In addition, there is a complex interplay of events that leads to hardening of the underlying bone along with bone spur formation and inflammation of the synovium (the lining of the joint), which causes further joint destruction.

OA is predominately a disease of weight-bearing joints. However, other joints can be affected and cause debilitating symptoms and loss of function.

The conventional approach to osteoarthritis hasn't changed for more than fifty years.

The three aims of treatment are to relieve symptoms, improve function, and restore cartilage. While the former two targets are sometimes reached, the latter has remained elusive.

OA treatment begins with non-medical interventions such as weight loss, physical therapy, exercise, patient education, and sometimes assistive devices. Assistive devices are things such as braces and canes that might help a patient perform activities of daily living more efficiently.

Many doctors advocate the use of analgesics (pain relievers) instead of traditional non-steroidal anti-inflammatory drugs (NSAID). This is because of the side effect profile of the latter group of medicines in light of data regarding cardiovascular events and gastrointestinal events associated with the use of these drugs.

One way of getting around this is to use NSAID in topical form. There are two preparations, Voltaren gel, and Pennsaid which are topical medicines containing the anti-inflammatory drug, diclofenac.

Nutriceuticals, such as glucosamine and chondroitin have their advocates. In addition various studies touting the benefits of dietary fish oil, and herbal remedies indicate these are also an option for people with mild OA. Glucocorticoid injections can be employed for patients with significant symptoms. They should be administered using ultrasound guidance and no more frequently than three times per year in an individual joint.

Viscosupplements, lubricants, can also be used although they are indicated so far for OA of the knee only. As with glucocorticoids, they should be administered using ultrasound guidance to ensure proper placement.

There is a huge void between these conservative therapies and surgery.

Recent experiences using autologous growth factors such as platelet-rich plasma (PRP) as well as autologous stem cells (a patient's own stem cells) may hold the promise of cartilage protection and cartilage regeneration.

(Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48)