Osteoarthritis Patient Treatment Strategies

The following strategies are listed with the simplest/cheapest/covered by insurance first

 

1. Nutrition

• Weight-loss

For every pound of weight you lose, you can decrease the force going through your knee joint by a factor of 2. That means if you lose 10 lbs, you will decrease the force through your knee joint by 20 lbs FOR EVERY STEP you take in a day. So if you take 1,000 steps, that would be equal to 20,000 pounds of force!

REFERENCES:

http://www.medscape.com/viewarticle/509928

http://www.arthritis.org/living-with-arthritis/arthritis-diet/losing-weight/weight-joint-pain.php

http://www.synviscone.com/knee-exercise-center/nutrition-and-weight-loss/weighing-the-benefits-of-dropping-a-few-pounds.aspx

 

• Low sugar/low carbohydrate diet

Diets high in sugar and carbohydrates are pro-inflammatory and can aggravate joint pain. Reduction of weight will also help to relieve the pressure on joints.

REFERENCE:

http://www.health.harvard.edu/family_health_guide/what-you-eat-can-fuel-or-cool-inflammation-a-key-driver-of-heart-disease-diabetes-and-other-chronic-conditions

 

2. Supplements

• Omega-3 Fatty Acid (3,000-4,000 mg/day)

This supplement has anti-inflammatory activity to relieve joint pain and stiffness.

REFERENCES:

http://www.medscape.com/viewarticle/856735?src=wnl_tp10j_160324_mscpedit&uac=146318MN&impID=1034686&faf=1

http://examine.com/supplements/Fish+Oil/

 

• Glucosamine and Chondroitin (1,500 mg/day of Glucosamine; 600 mg/day of Chondroitin)

These supplements promote building of cartilage.

REFERENCES:

Ann Rheum Dis doi:10.1136/annrheumdis-2014-206792

http://examine.com/supplements/Glucosamine/

 

• Vitamin D (5,000-10,000 mg/day with food)

This supplement is important for many different bodily functions including the immune system, cardiac health, and bone and joint function. There is evidence that this supplement aids in reduces pain.

REFERENCES:

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

http://lpi.oregonstate.edu/mic/vitamins/vitamin-D

 

• Curcumin (1,000 mg 3 times/day as needed)

This supplement, also known as Tumeric, is used as a natural anti-inflammatory and is as effective as taking 1000 mg of ibuprofen 3 times per day.

REFERENCES:

https://examine.com/supplements/curcumin/

http://draxe.com/turmeric-benefits/

 

• Arnica Gel and/or Pellets

Either apply the gel to the affected area 3-4 times per day, or place 10 pellets under the tongue 3-4 per day as needed for pain. This supplement is a homeopathic anti-inflammatory that is used to reduce both pain and inflammation.

REFERENCES:

• Widrig, Reto, Andy Suter, Reinhard Saller, and Jörg Melzer. "Choosing between NSAID and Arnica for Topical Treatment of Hand Osteoarthritis in a Randomised, Double-blind Study." Rheumatol Int Rheumatology International 27.6 (2007): 585-91. Web

 

3. Biomechanics

• Physical Therapy/Strengthening

Strengthening the muscles around the joint, especially the quadriceps muscle, (as well as other related muscles elsewhere in the body) can help to provide support to the joint and takes the stress off it. Focus also on strengthening the hip muscles, and more importantly the hip Abductors.

REFERENCES:

http://www.arthritis.org/living-with-arthritis/exercise/benefits/osteoarthritis-exercise.php

http://www.health.harvard.edu/family_health_guide/exercise-rx-for-overcoming-osteoarthritis

 

4. Knee bracing

• Unloader braces

These braces can take the force away from (i.e. unload) the painful arthritic part of the knee and have more force go through the healthier part of the knee.

REFERENCES:

http://www.oandp.org/AcademyTODAY/2009Mar/4.asp

http://www.healio.com/orthopedics/journals/ortho/2011-8-34-8/%7Bcceb555e-acaa-4481-ab96-d7e72ddd5441%7D/long-term-results-of-an-unloader-brace-in-patients-with-unicompartmental-knee-osteoarthritis

 

• OrthoCor Braces

This is a wearable and portable device that stimulates the knee with Pulse Electromagnetic Field Therapy, and the patient wears it for two hours per day to promote the healing of tendons and cartilage. See Brochure for more details.

REFERENCE:

http://www.orthocormedical.com/

 

5. Orthotics

Foot orthotics can help to decrease the forces through the painful part of the knee to relieve joint pain, especially in patients who have flat feet.

REFERENCES:

https://www.painscience.com/articles/orthotics.php

http://kneepaininfo.com/orthoticspatellofem.html

http://www.arthritis.org/living-with-arthritis/pain-management/joint-protection/foot-pain-shoe-inserts.php

 

6. Injections

• Cortisone injections

These injections can be helpful when there is truly swelling and inflammation within the knee joint; however, recent medical literature has shown that cortisone has toxic effects to both cartilage and tendon cells and therefore, the short-term benefit can result in longer term detrimental effects. We therefore, try to avoid cortisone injections in the treatment of osteoarthritis or cartilage issues.

REFERENCE:

http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/corticosteroids/corticosteroid-injections.php

 

• Prolotherapy Injections (Dextrose)

These injections have been shown to improve knee osteoarthritis and have positive chondrogenic effects in patients with severe osteoarthritis. This has also been used previously to treat musculoskeletal pain. Prolotherapy can ultimately be a safe aid in triggering a natural healing process of damaged tissue in the joint.

REFERENCES:

http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/other/prolotherapy-knee-oa.php

http://prolotherapycollege.org/what-is-prolotherapy/

 

• Lubricating injections (Synvisc, Orthovisc, etc.)

Lubricating agents are injected to provide pain relief. This may be covered by insurance.

REFERENCE:

http://www.arthritis.org/living-with-arthritis/treatments/medication/drug- types/corticosteroids/corticosteroid-injections.php

 

• Platelet Rich Plasma (PRP)

A sample of your own blood is drawn and concentrated for platelets. These platelets are then injected to promote healing. This procedure is not covered by insurance. Click here for more information.

REFERENCE:

Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 2015:8 1–8 doi: 10.4137/CMAMD.S17894.

 

• Lipogems Therapy

Lipogems is a procedure that involves harvesting adipose tissue, usually from the lower abdomen, using an FDA approved method which cleanses the fat and breaks it down into smaller particles, ultimately filling defects in a specific joint and releasing growth factors. See Brochure for more details.

 

• Regenerative Medicine (aka Stem Cell Therapy)

Cells are collected from your own bone marrow and then injected to promote healing. This procedure is not covered by insurance. Click here for more information.