25 Treatments for Hip and Knee OA
New guidelines offer consistent recommendations for doctors worldwide.
When it comes to treating osteoarthritis, you may have more options than you realize. Now your doctor has new guidelines to help her – and you – chose among those many options.
The guidelines, published by the Osteoarthritis Research Society International (OARSI) in the journal Osteoarthritis and Cartilage, are the first evidence-based recommendations developed by a committee of international experts brought together by OARSI, a nonprofit organization dedicated to promoting osteoarthritis research and treatment. The goal was to eliminate inconsistent treatment approaches by creating simple guidelines that would enable healthcare providers to determine which therapies would be most useful for an individual patient, says Francis Berenbaum, MD, PhD, president elect of OARSI and a faculty member in the Department of Rheumatology at Pierre & Marie Curie University in Paris.
The committee took the scientifically proven commonalities it found in the international literature, evaluated the level of scientific evidence, proposed a strength of recommendation for each modality, and then condensed them into one comprehensive “playbook” of what works, says OARSI president Steve Abramson, MD, director of rheumatology and professor of medicine at New York University School of Medicine.
The first of the 25 recommendations is that optimal treatment requires both drug and non-drug treatments. The remaining 24 fall into three categories: non-drug, drug and surgical.
Following are the recommendations:
1. Drug and non-drug treatments. The optimal osteoarthritis treatment program should consist of both medications and non-drug treatments.
Non-Drug Treatment
2. Education and self-management. The initial focus of treatment should be on what patients can do for themselves, rather than on passive therapies delivered by a health professional. Learn about the Arthritis Foundation Self-Help Program.
3. Regular telephone contact. The best evidence for the benefit of phone contact came from a study of 439 OA patients in which monthly phone calls from lay personnel promoting self-care was associated with improvements in joint pain and physical function for up to a year.
4. Physical therapy. Studies consistently support the usefulness of an evaluation by a physical therapist and instruction in appropriate exercise to reduce pain and improve function. Physical therapists can also provide assistive devices to make daily tasks easier.
5. Aerobic, muscle-strengthening and water-based exercises. A rounded exercise program can promote muscle strength, improve range of motion, increase mobility and ease pain. Read Arthritis Today articles on fitness and exercise.
6. Weight loss. Maintaining your recommended weight or losing weight if you are overweight can lessen your pain by reducing stress on your affected joints. Weight loss specifically helps ease pressure on weight-bearing joints such as the hips and knees. Read Arthritis Today’s special weight-loss guide.
7. Walking aids. Canes and crutches can reduce pain in hip and knee or OA. If both hips and/or knees are affected wheeled walkers may be preferable.
8. Footwear and insoles. If OA affects the knee, special footwear and insoles can reduce pain and improve walking.
9. Knee braces. For OA with associated with knee instability, a knee brace can reduce pain, improve stability and reduce the risk of falling. Read Bracing: One Treatment Option for Arthritis and Brace Yourself Against Knee OA Pain.
10. Heat and cold. Many people find the heat of a warm bath, heat pack or paraffin bath eases OA pain. Others find relief in cold packs. Still others prefer alternating the two. Learn more about using heat and cold.
11. Transcutaneous electrical nerve stimulation (TENS). A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain. It has been shown to help with short-term pain control in some patients with knee or hip OA.
12. Acupuncture. A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been touted as a treatment for osteoarthritis pain. A recent trial of 352 patients with knee OA showed small but statistically significant improvement in pain intensity at two and four weeks following a course of acupuncture.
See Page 2 -- Drug Treatment for OA
