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 Arthritis

Treating Arthritis
Dr Jayateerth W Kulkarni
 
The condition of arthritis gives rise to pain, restriction of movement and deformity. People affected with arthritis are known to have difficulty with routine activities of daily living such as walking, sitting, dressing, feeding etc.,

depending on which joints are affected. In severe cases, patients suffer pain even at rest and during sleep, which leads to despair and agony.

The treatment plan for arthritis helps patients to deal with the condition, though there is no known cure for it that could help reverse the condition. In early stages of arthritis, the following could be suggested towards treatment:

  • Modification of activities
  • Weight reduction
  • Use of stick / walking aid
  • Exercises
  • Physiotherapy
If these do not work, medications are prescribed, which are generally paracetamol (acetaminophen), non-steroidal anti-inflammatory agents (NSAIDs) and opiates.   In inflammatory arthritis, especially rheumatoid arthritis, aggressive treatment with a combination of DMARDS (Disease-modifying antirheumatic drugs) within the first 3-6 months of diagnosis will permanently alter the course of the disease progression. But in the event of delay, the efficacy of this treatment is lessened.
When oral medications do not give relief, injections in the joint can also be given. Steroid injections are suitable for small joints of the hand and feet. They are generally avoided in large joints and when the arthritis is severe. There is a risk of infection and accelerated degeneration of the lining of the joint cartilage with repeated usage.
Viscosupplementation with hyaluronic acid injections gives short term relief in early osteoarthritis. This procedure is less effective when arthritis is advanced or associated with adverse factors like obesity, mal-alignment or deformity. They are not effective for inflammatory types of arthritis.

Surgical options are also available for treating arthritis. These include:

  • Arthroscopy (keyhole surgery) – helps by washing the joints debris. Unstable tears of the cushions (meniscus) or joint lining (synovitis) can be excised offering some relief from pain. Small defects of the lining surface can be freshened by chondroplasty and microfracture techniques with variable benefit.
In general, arthroscopy is helpful in early arthritis. It is not effective when arthritis is advanced. It is generally not used for inflammatory arthritis.
  • Osteotomy – helps in correcting mal-alignment in order to shift the weight to the more healthy side of the joint. This unloads the arthritic part of the joint. This gives relief from pain, and is especially useful in younger patients. The pain relief is not complete because there is usually some arthritis in the less involved area of the joint as well.
  • Joint Replacement: In this procedure, the natural surfaces of joint are replaced by artificial bearing surfaces. This provides a lasting relief from pain, restores movements to joints, and deformities are corrected as a part of this procedure. There is no need for any analgesics or any other medications after joint replacements. Certain precautions and lifestyle modifications are necessary after the replacement, like avoiding sitting on the floor, avoiding vigorous athletic activities and contact sports, the need for a western type of toilet, etc.
     
  • Other operations: like osteochondral auto-grafting, chondrocyte/cartilage transplantation, osteochondral allografting are applicable to highly selected patients with limited bone/cartilage defects, and are generally not applicable to arthritis which affects a large area or the whole of the articular surfaces of the joint. 
 
Dr Jayateerth W Kulkarni is Senior Consultant Orthopedic Surgeon, Apollo Hospitals, Bangalore.

    
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