Modalities of Treatment

There are many different modalities to the treatment of arthritis.

1. Patient education about the condition and it's treatment is important. Self-help groups are organized by arthritis charities such as the Arthritis Research Council. Self-management programmes are aimed at teaching attitude change and coping skills. There is some scientific evidence that education reduces pain and disability in hip or knee arthritis.

2. Physiotherapy, stretching and muscle strengthening are important in the management of OA, especially in maintaining flexibility, mobility and in the use of walking aids.

3. Weight reduction reduces the risk of developing OA of the knees, and helps reduce pain and progression of the wearing process.

4. Medication is used to control pain. Analgesics such as Paracetamol, Codydramol are commonly used. Non-steroidal anti-inflammatory drugs (NSAIDS) have a specific anti-inflammatory action and the most commonly used drugs to control pain, swelling and stiffness from arthritis.

5. NSAID creams to the joints can be helpful. Heat rubs are effective. It is uncertain if NSAID applied as a cream have any beneficial effect.

6. Injection of corticosteroids into the joint is a common treatment for arthritic joints. However though this may be very effective in providing control of pain and swelling in the short term there is the possibility that the progression of arthritis will not be helped and possibly advanced. Multiple injections are not thought to be usually beneficial.

7. Glucosamine and Chondroitin Sulphate. These substances are widely available, advertised and taken in vast quantities around the world. There is little objective scientific verifiable and reproducible evidence of a significant benefit. However many patients report some relief of the symptoms of pain and stiffness following their use. However the drug is freely available but differs tremendously in respect of the active compound and the strength of the active compound in each proprietary product.

8. Injection of hyaluronic acid or viscosupplementation is helpful in arthritis. It is commonly used in knee arthritis. The improvement in symptoms has been shown to be equivalent to a steroid injection with few side effects and no significant acceleration of the degeneration unlike corticosteroid injection. In most products a series of three repeated injections are required. The therapy can be repeated after an interval of several months. However the therapy is expensive and medical insurers may be reluctant to reimburse the costs.

9. Joint Arthroscopy and washing out has been widely shown to be ineffective in providing significant improvement of the symptoms of arthritis. NICE recently published advice to this effect.

10. Arthroscopy and debridement on the other hand has been widely reported to result in significant benefits to the patients in respect of pain relief, improvement of the symptoms which may be significant and prolonged. The degree of improvement very much depends on the extent of the arthritis and the stage of the arthritic process present at the time of surgery.

11. Joint replacement. Total Hip or Knee replacement has been undertaken for 40 years or more. Currently over 100,000 joint replacements are undertaken in the UK each year. The vast majority of patients are able to return to their normal activities and have a significant improvement. In fact the procedures have became some of the most commonly performed and successful surgical procedures in respect of improvement in symptoms and restoration of function.

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