Osteoarthritis of the hip. Arthritis Rheum ; Patient Education. Arthritis self-help courses conducted by allied health professionals teach patients how to manage their disease. Participation in such courses has been associated with decreased pain and improved quality of life.
Local chapters of the Arthritis Foundation administer self-help courses for patients with osteoarthritis. Regular patient contact has also been shown to be valuable in the management of osteoarthritis.
One study found that monthly telephone communications with patients were cost-effective and were associated with good clinical outcomes. However, the available evidence shows that regular low-impact exercise of osteoarthritic joints does not increase the development of osteoarthritis. The goals of an exercise program are to maintain range of motion, muscle strength and general health.
All patients with osteoarthritis of the knee should be taught quadriceps-strengthening exercises and should be encouraged to perform them every day. Patients may also be referred to aerobic exercise programs such as fitness walking or swimming.
Patients with osteoarthritis who participate in an aerobic exercise program have been shown to have improved aerobic capacity and ft walking times, as well as decreased depression and anxiety, compared with patients who only perform range-of-motion exercises. Assistive Devices. Many patients with osteoarthritis of the hip and knee are more comfortable wearing shoes with good shock-absorbing properties or orthoses. The use of an appropriately selected cane can reduce hip loading by 20 to 30 percent.
The top of the cane's handle should reach the patient's proximal wrist crease when the patient is standing with arms at the side. The cane is usually held on the unaffected side of the body. Patients with specific physical disabilities may benefit from physical and occupational therapy. The physical therapist can provide an individualized exercise program and teach the patient how to use therapeutic heat and massage.
An occupational therapist can determine whether the patient needs assistive devices such as a raised toilet seat. In addition, special splints can be designed to stabilize or reduce inflammation of particular joints, such as the first carpometacarpal joint or the base of the thumb. Weight Management. There is a longitudinal association between obesity and osteoarthritis of the knee in men and women, although obesity is a greater risk factor in women.
It is not clear whether weight loss will improve symptoms in patients who are already experiencing symptoms of osteoarthritis of the knee. Although small trials conducted in Europe and the United States showed some efficacy for these agents, 20 , 21 the trials were flawed in design and included few patients. Randomized controlled trials are currently being conducted to determine whether glucosamine sulfate and chondroitin sulfate are safe, tolerated and effective in patients with osteoarthritis.
At present, these supplements cannot be recommended for use in the treatment of osteoarthritis. Simple Analgesics. A large number of medicines are prescribed for and consumed by patients with osteoarthritis, largely for the relief of pain.
The recognition that pain in osteoarthritis is not necessarily due to inflammation has led to an increased awareness of the role of simple analgesics in the treatment of this disease. The ACR guidelines emphasize the use of acetaminophen as first-line treatment for osteoarthritis of the hip and knee.
Opioid-containing analgesics, including codeine and propoxyphene Darvon , can be used for short periods to treat exacerbations of pain. These agents are not recommended for prolonged use because they cause constipation and increase the risk of falling, particularly in the elderly. Trials comparing simple analgesics and NSAIDs found that acetaminophen alone can control pain in a substantial number of patients with osteoarthritis.
In the individual patient, cost, dosing frequency and medication tolerance may influence NSAID selection. The risk of NSAID-induced renal and hepatic toxicity is increased in older patients and in patients with preexisting renal or hepatic insufficiency. Thus, it is important to monitor renal and liver function. Nonacetylated salicylates such as choline magnesium trisalicylate Trilisate and salsalate Disalcid cause less renal toxicity.
The authors of this article recommend that liver function tests and serum hemoglobin, creatinine and potassium measurements be performed before NSAID therapy is initiated and again after six months of treatment. Use of multiple nonsteroidal anti-inflammatory drugs or use of a high dosage of one of these drugs. Non-steroidal antiinflammatory drugs and the gastrointestinal tract.
The double-edged sword. When used as cotherapy in patients requiring chronic NSAID treatment, misoprostol Cytotec , a synthetic prostaglandin E 1 analog, helps to prevent gastric ulcers. The ACR provides no specific guidelines for the prevention and treatment of active ulcer disease and its complications in patients with osteoarthritis who are receiving NSAIDs. New Developments. COX-1 is expressed in gastric and renal tissues among others , whereas COX-2 is inducible and is part of the inflammatory response.
In a recent study, celecoxib effectively alleviated pain and reduced inflammation but showed no evidence of inducing gastric ulcers or affecting platelet function two toxic effects associated with COX-1 inhibitors.
The most common side effects of celecoxib are dyspepsia, diarrhea and abdominal pain. An additional COX-2 inhibitor, rofecoxib Vioxx , has also been labeled as a once-daily medication for the treatment of osteoarthritis and acute pain. Clinical trials showed that rofecoxib was as effective as ibuprofen and diclofenac and was significantly superior to placebo in the treatment of pain in patients with osteoarthritis.
Local Analgesics. Capsaicin e. One double-blind randomized, controlled trial showed that 0. Another trial found that patients with osteoarthritis or rheumatoid arthritis who were receiving conventional therapy generally experienced substantial diminution of pain following application of capsaicin cream to the affected joint.
Capsaicin cream is available over the counter in concentrations of 0. One common side effect is a local burning sensation. Patients should be advised to apply capsaicin cream with a glove to prevent inadvertent spread to the eyes or other mucous membranes. Intra-articular Corticosteroid Injections. Patients with a painful flare of osteoarthritis of the knee may benefit from intra-articular injection of a corticosteroid such as methylprednisolone Medrol or triamcinolone Aristocort.
A joint should not be injected more than three or four times in one year because of the possibility of cartilage damage from repeated injections. Patients who require more than three or four injections per year to control symptoms are probably candidates for surgical intervention. Patients with painful osteoarthritis of the hip may benefit from intra-articular corticosteroid injections.
These injections should be performed under fluoroscopic guidance. Hyaluronic acid is a major nonstructural component of the synovial and cartilage extracellular matrix. It confers viscoelastic and lubricating properties to the joint. In patients with osteoarthritis, the concentration and the molecular weight of hyaluronic acid are decreased. Thus, viscosupplementation with hyaluronic acid—like products is thought to be a possible treatment for osteoarthritis.
The FDA has labeled sodium hyaluronate Hyalgan and hylan G-F 20 Synvisc injections for the treatment of pain caused by osteoarthritis of the knee. One study on intra-articular hyaluronate injections in osteoarthritis of the knee found no difference in pain, function or global evaluation between treatment and placebo groups.
Another study found that when used as a replacement or an adjunct for NSAID therapy in patients with osteoarthritis of the knee, hylan G-F 20 injections were at least as effective as continuous NSAID therapy in all outcome measures except activity restriction. Patients whose symptoms are not adequately controlled with medical therapy and who have moderate to severe pain and functional impairment are candidates for orthopedic surgery.
Osteoarthritis of the knee that is complicated by internal derangement may be treated with arthroscopic debridement or joint lavage. Osteotomy may be performed if significant malalignment of the knee or hip joints is present. Total joint arthroplasty usually has an excellent outcome and markedly improves quality of life. Most investigational therapies are targeted toward the inhibition of collagenolytic enzymes using, for example, oral doxycycline Vibramycin or specific metalloproteinase inhibitors.
Other developments include tissue engineering using autologous chondrocytes cultured in vitro and reintroduced into the joint.
The clinical applications of these approaches are currently limited to research settings. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Manek graduated from the Faculty of Medicine at the University of Glasgow, Scotland, and completed a residency in internal medicine at Loma Linda Calif.
University Medical Center. Address correspondence to Nancy E. Lane, M. Reprints are not available from the authors.
She has also been on the speakers bureaus of Merck and Co. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States.
J Rheumatol. Osteoarthritis symptoms can usually be managed, although the damage to joints can't be reversed. Staying active, maintaining a healthy weight and receiving certain treatments might slow progression of the disease and help improve pain and joint function.
The hip joint shown on the left side of the image is normal, but the hip joint shown on the right side of the image shows deterioration of cartilage and the formation of bone spurs due to osteoarthritis. Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:. Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that enables nearly frictionless joint motion.
Osteoarthritis has often been referred to as a wear and tear disease. But besides the breakdown of cartilage, osteoarthritis affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of the joint lining.
Osteoarthritis is a degenerative disease that worsens over time, often resulting in chronic pain. Joint pain and stiffness can become severe enough to make daily tasks difficult. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Updated visitor guidelines. Top of the page. Comparing Rheumatoid Arthritis and Osteoarthritis.
Topic Overview Rheumatoid arthritis and osteoarthritis are different types of arthritis. Characteristics of rheumatoid arthritis and osteoarthritis Characteristic Rheumatoid arthritis Osteoarthritis Age at which the condition starts It may begin any time in life. It usually begins later in life. Speed of onset Relatively rapid, over weeks to months Slow, over years Joint symptoms Joints are painful, swollen, and stiff.
Joints ache and may be tender but have little or no swelling. Pattern of joints that are affected It often affects small and large joints on both sides of the body symmetrical , such as both hands, both wrists or elbows, or the balls of both feet.
Duration of morning stiffness Morning stiffness usually lasts longer than 1 hour. Presence of symptoms affecting the whole body systemic Frequent fatigue and a general feeling of being ill are present.
Whole-body symptoms are not present.
0コメント