Arthritis occurs when the normal smooth articular cartilage lining the joints is damaged. Initially the cartilage becomes rough and thinned, but is still present. In this stage the patients complain of some mechanical type symptoms such as catching, and possibly swelling, and aching type pain which increases with activity. As the arthritis becomes more severe, and as bone is ultimately exposed, the pain becomes correspondingly more severe. Eventually the patients may have pain with only minimal activity, and even have pain at rest. Arthritis may follow a specific injury which causes damage to the articular cartilage and subsequent progressive deterioration. Arthritis may also be due to repetitive overuse or minor injury to the joint. Some patients will have a rheumatologic process, such as rheumatoid arthritis or gout, which causes inflammation in the joint and causes the joint to deteriorate. Such a problem will commonly effect multiple joints with a symmetrical location. In some patients, there may also be a genetic component.
Treatment for arthritis depends on the stage of arthritis and the patient’s level of symptoms. In the minor stages, treatment consists of anti-inflammatory medication to reduce inflammation, weight loss if necessary, and activity modification. Some patients also report benefit with over the counter dietary supplements such as Glucosamine and Chondroitin Sulfate. Several studies have shown that approximately 50 percent of patients taking these supplements may have some improvement in their arthritic symptoms. However these medications have not been well studied since these are not prescription medications. Moderate exercise is helpful in maintaining strength and range of motion, and may also help to decrease pain. However patients should avoid high impact activities which put increased stresses on the damaged joint surfaces. Bicycle riding, swimming, and isometric strengthening exercises are often helpful in relieving symptoms without causing increased pain.
Injections may be helpful in patients with arthritic problems. Injection of a corticosteroid may be very effective in rapidly relieving pain and inflammation in an arthritic joint. Corticosteroids work rapidly, but the effects are often only temporary, and the inflammation may recur. Also, repeated corticosteroid injections may result in weakening of the ligaments, meniscus or articular cartilage within the joint. This is less of a concern in patients who already have severe degenerative arthritis, but in patients with less arthritis, it is prudent to limit corticosteroid injections to no more frequently than every three months, and generally to no more than two or three injections total into the joint.
Another option is injections with hyaluronic acid. These go by the trade names of Euflexxa, Synvisc, Hyalgan or Supartz. Euflexxa and Synvisc is a series of three injections and Hyalgan and Supartz a series of five injections given at weekly intervals into the joint. These medications are generally slower in onset, but give more prolonged symptom relief than is the case for corticosteroids. Not all patients will respond to these injections, but approximately 80 percent will have some response, with an average response being approximately six to twelve months.
Finally another nonsurgical option is Platelet Rich plasma (PRP) treatment. PRP treatment has been shown in clinical studies to provide even greater symptomatic relief than viscosupplementation when given on a once a week for 3 week basis.
Ultimately if the patient is not responsive to nonsurgical treatment then arthroplasty may be required.
