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Management of Arthritis and Joint Pain. Taylor Brown, M.D. Orthopedic Surgery and Sports Medicine. What is Arthritis?. Swollen or painful joint. What is Arthritis?. Loss of the cartilage that covers the ends of each bone Abrasion or wearing away
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Management of Arthritis and Joint Pain Taylor Brown, M.D. Orthopedic Surgery and Sports Medicine
What is Arthritis? • Swollen or painful joint
What is Arthritis? • Loss of the cartilage that covers the ends of each bone • Abrasion or wearing away • Inflammation that erodes and irritates the joint
What is Arthritis? • Causes or etiology • Osteoarthritis • Inflammatory arthritis • Crystals = gout or pseudogout • Rheumatoid, lupus, psoriatic • Infectious or post-infectious reactive
Arthritis Symptoms • Pain • Swelling • Stiffness • Loss of function
Arthritis Symptoms • Crunching • Grinding • Giving Way • Instability • Weakness
Arthritis Treatment Goals • Reduce your pain • Improve your function
Arthritis Treatment Goals • There is no validated way to regrow the lost cartilage
Arthritis Treatment Options • Osteoarthritis = wear and tear arthritis
Arthritis Treatment Options • Applicable to all arthritic symptomatic joints • Treatment spectrum • Low risk/reward • Higher risk/reward • You choose what treatment you want
Arthritis Treatment Options • Live with it – no risk, no reward
Arthritis Treatment Options • Activity and Lifestyle modification • if it hurts don’t do it • Weight loss = aquatic programs
Arthritis Treatment Options • Physical Therapy – increased strength and flexibility can decrease your symptoms • Muscles are the shock absorbers for joints
Arthritis Treatment Options • Braces • Soft knee sleeve may decrease pain with warmth and compression • Unloader braces may take pressure off of a single portion of your knee
Arthritis Treatment Options • Cane or Walker – may unload pressure on hip, knee, or ankle joints at the cost of your shoulders
Arthritis Treatment Options • Oral medications • Tylenol • Aspirin • Ibuprofen = advil • Naproxen = aleve
Arthritis Treatment Options • Oral medications • Celecoxib = celebrex • Meloxicam = mobic • Indomethacin • Arthrotec • Lodine • So many more
Arthritis Treatment Options • Oral supplements • Glucosamine • Chondroitin sulfate • MSM • proline • help half the time • None of these will make cartilage grow back, but they may improve your pain and function
Arthritis Treatment Options • Topical remedies • NSAID gel or patch • Voltaren gel • flector patch • ketoprofen cream • Lidocaine patch • lidoderm • OTC • Capsaicin • menthol
Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • viscosupplements
Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • Single injection • Okay for any joint • Pain relief within several days • 3 months typical relief
Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • May accelerate arthritis and cartilage breakdown • Helps 2 of every 3 people • Will increase blood sugar levels for 2 to 3 days in patients with diabetes
Arthritis Treatment Options • Injectable therapy • Viscosupplements • Hyaluronic acid • Viscous liquid • Closely approximates normal joint fluid characteristics • Gone from the knee within days • Effect lasts 6 to 12 months
Arthritis Treatment Options • Injectable therapy • Viscosupplements • Hyaluronic acid • 3 to 5 weekly injections • Only FDA approved for the knee currently • Ongoing studies for shoulder and ankle
Arthritis Treatment Options • Injectable therapy • Viscosupplements • Needs several weeks for effect to be noticed • Most are avian derived • Bacteria derived synthetic product available • Helps 3 of 4 people
Arthritis Treatment Options • Surgical options • Arthroscopic • Joint Replacement = arthroplasty • Osteotomy = realignment
Arthritis Treatment Options • Surgical options • Arthroscopic • Lavage = wash out • Debridement or chondroplasty= clean up and smooth • Microfracture = stimulate with a drill to generate fibrocartilage – not hyaline or articular cartilage • Transplant = auto or allo OATS = rob peter (or donor) to pay paul • Carticel = aci = autologous chondrocyte implantation
Arthritis Treatment Options • Surgical options • Arthroscopic • Lavage = wash out
Arthritis Treatment Options • Surgical options • Arthroscopic • Debridement or abrasion chondroplasty= clean up and smooth
Arthritis Treatment Options • Surgical options • Arthroscopic • Microfracture = stimulate with an awl to generate fibrocartilage – not hyaline or articular cartilage
Arthritis Treatment Options • Surgical options • Arthroscopic • Transplant = auto or allo OATS = rob peter (or cadaver) to pay paul
Arthritis Treatment Options • Surgical options • Arthroscopic combined open • Carticel = aci = autologous chondrocyte implantation • Works well in sweeden
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Use metal or plastic to replace lost cartilage • Open surgery • 3 month recovery • Physical therapy after • 10 to 20 years of relief
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • knee
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • hip
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • shoulder
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Shoulder resurfacing
Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Biologic shoulder resurfacing
Arthritis Treatment Options • Surgical options • Osteotomy = realignment • Break the leg to remove pressure from the arthritic portion of the knee and place more pressure on the normal portion of the knee
Arthritis Treatment Goals • Reduce your pain • Improve your function • There is no validated way to regrow the lost cartilage
Arthritis Treatment Options • Activity and Lifestyle modification • Physical therapy, braces, canes • Oral medication and supplements • Topical medications • Injectable medications • Surgical options • Arthroscopic • Arthroplasty