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Osteoarthritis Treatment Algorithms

There are many published peer reviewed guidelines for the management of osteoarthritis^1,2,3. Although the guidelines are generic, it is recommended that the treatment of arthritis should be individualised to the patient¹.

Currently there are no pharmaceutical treatments which offer chondroprotection or disease modification in OA. Treatments are focused purely upon symptomatic improvement and improving quality of life through coping strategies.

Overall, the goals of managing OA include controlling pain, improving the range of movement of the affected joints, and limiting functional impairment.

Formal treatment starts with non interventional therapies like weight loss and Physiotherapy, moving towards pharmaceutical management of pain, followed eventually by surgical interventions. Below we have outlined a brief resume of the most commonly available treatment options.

Non Pharmaceutical Management includes:

• Education
• Weight loss
• Exercise
• Mechanical aids, braces, splints, orthotics and ambulatory devices
• Massage
• Physiotherapy

Pharmaceutical Management includes:

• Paracetamol (OTC)
• Oral chondroitin and glucosamine supplements
• Topical NAIDS (non steroidal anti inflammatory drugs)
• Oral NSAIDs, OTC and prescription (Ibuprofen, Naproxen etc)
• COX II specific NSAIDs
• Intra articuar injection
• Viscosupplementation (Durolane)
• Intra articular steroids
• Opiods

Surgical Management includes:

• Arthroscopy
• Osteotomy
• Arthroplasty (total or unicompartmental joint replacement)

Viscosupplementation has been used successfully now by orthopaedic surgeons and Rheumatologists who have found that the single injection treatment regime gives them extended treatment options in patients who are at a high risk of NSAID related side effects, or for those in whom it would be preferable to delay or avoid surgery.

Download the Durolane Physician Brochure (PDF) for more information.

> Resources

References

Reference 1: Recommendations for the medical management of osteoarthritis of the hip and knee. Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TJ. Arthritis Rheum 2000; 43: 1905-1915.

Reference 2: EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Pendelton A, Arden N, Dougados M, et al. Ann Rheum Dis 2000; 59: 936-944.

Reference 3: Viscosupplementation for the treatment of osteoarthritis of the knee. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G The Cochrane Database of Systematic Reviews 2007 Issue 2