Osteoarthritis is a degenerative disease of joints. Arthritis pain limits activity and negatively affects quality of life. For those patients with chronic medical problems, activity limitations from osteoarthritis can affect their ability to control diabetes, high cholesterol, and high blood pressure. An estimated 27 million Americans age 25 and older have osteoarthritis. Our goal is early detection and comprehensive management and improving the quality of life.
Let our comprehensive team of experts diagnosis and provide evidence based high quality treatment to get your osteoarthritis related symptoms under control to get you back to the healthy life style you deserve.
In a healthy joint, the ends of bones are lined by smooth but hard tissue called cartilage. The joint is wrapped by a joint capsule lined with a synovial membrane that produces joint(synovial) fluid. The capsule and fluid protect the cartilage, muscles, and connective tissue.
Osteoarthritis affects the joint as a whole: cartilage, bone, joint lining and the joint fluid.
In Osteoarthritis, the surface layer of cartilage breaks down and wears away due to mechanical loading (wear and tear) and inflammation. This allows bones under the cartilage to rub together as the disease advances causing:
– Increased abnormal (new) bone formation as a response to micro injury.
– Decrease in viscosity of joint fluid (synovial fluid) with progressive loss of lubricant action and increasing friction between the articular cartilage.
– Synovitis : Inflammation of the lining of the joint called synovium
Though it is considered to be non-inflammatory arthritis, there is evidence supporting that inflammation is the underlying process that perpetuates the progression of osteoarthritis. Increased inflammatory mediators are found in the joint fluid.
Our Collaborative Partners
Exercise is one of the best treatments for osteoarthritis. It is recommended that you complete at least 150 minutes of moderate exercise per week. Exercise has been proven to improve mood, decrease pain, increase flexibility and strengthen , improve blood flow to the heart, help with maintaining weight, and promote general physical fitness. Walking, swimming and water aerobics are a few popular types of exercise for people with osteoarthritis. Please speak to your doctor and/or physical therapist about specific types of exercise depending on your particular situation. People with osteoarthritis often develop muscle weakness due to inhibition from joint pain. Appropriate exercise can rebuild muscle strength, which has been shown to in turn decrease pain and improvement function.
- Strengthening exercises: strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands
- Aerobic activities: brisk walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape
- Range-of-motion activities
- Balance and agility exercises
For those who are overweight, losing weight can improve symptoms of osteoarthritis. One pound of extra weight is four pounds on the knee joint. There is lot of extra loading of the joints with increased weight and is detrimental to joint health. Diet plus exercise is better than either alone. A dietitian can help you develop healthy eating habits.
Physical therapy can help you to improve strength and range of motion. In addition, physical therapy can address any biomechanical issues that may be contributing to your pain from osteoarthritis. This includes assessing the need for insoles, orthotics, or kneecap and foot taping.
Weight loss, Physical therapy and exercises have been proven to slow progression of osteoarthritis.
Hand splints provide pain relief and support. Knee braces reduce pain, improve stability and diminish risk of falling.
Tylenol (acetaminophen) is primarily prescribed as the first line of treatment. If that doesn’t produce the desired results NSAIDs, such as ibuprofen are often prescribed. If the pain is severe, Tramadol and opioids can be prescribed after full evaluation. These medication are typically only used for short durations. NSAIDS should be limited to 10 to 4 days . Acetaminophen is the preferred long term pain control which is found to be safe.
Oral corticosteroids like prednisone are not routinely used to treat osteoarthritis.
Medications can interact with one another and certain health conditions put you at increased risk of drug side effects, it’s important to discuss your medication and health history with your doctor before you start taking any new medication.
Ultrasound Guided Injections
A Corticosteroid injection is a powerful anti-inflammatory and is often used to provide relief from osteoarthritis, especially if symptoms are not responding to oral therapy/ conservative management. It’s effective for painful flares and can provide relief for several months. Injections can be done every three months (about 4 times per year).
Viscosupplementation (Synvisc, hyalgan,Euflexxa)- Hyaluronic acid substitutes are designed to replace a component of the joint involved in joint lubrication and nutrition. It is a lubricant and anti-inflammatory that helps with inflammation in the joint fluid. It is a series of injections 1 per week for 3-5 weeks. These products are approved only for osteoarthritis of the knee.
PRP (Platelet Rich Plasma): Recent studies suggest PRP is more effective than viscosupplementation in knee osteoarthritis. Larger randomized controlled studies are needed to make it a routine part of management. This is not covered by insurance at this time.
Non-invasive treatment options
TENS unit: TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It works by blocking pain messages to the brain and by modifying pain perception.
Acupuncture: Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. The needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.
Massage: In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This increases blood flow and brings warmth to the stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.
Glucosamine/chondroitin: Sometimes Glucosamine and/or chondroitin can be used to improve symptoms, however, results can vary. Current evidence does not support long term use. As per guidelines , they can be tried over the course of 3-6 months and stopped if there is no improvement. Research is still being conducted on the benefit of these supplements.
Patients with hip or knee osteoarthritis who are not obtaining adequate pain relief and functional improvement from a combination of pharmacological and non-pharmacological treatment should be considered for joint replacement. A decision to have a joint replacement is not based on imaging but is made collectively between a patient and an orthopedic surgeon with expertise in surgical management of osteoarthritis. Replacement arthroplasties are effective interventions for patients with significant symptoms and or functional limitations not responsive to conservative care. The appropriate time to have a joint replacement surgery is different for every patient.
Platelet Rich Plasma Injections
What is Platelet Rich Plasma (PRP)?
Platelet rich plasma is a concentration of growth factors and platelets from a small amount of your own blood. This therapy provides increased levels of growth factors that are thought to improve signaling and recruitment of cells to an injury site. The goal is to optimize the environment for healing and it has been used to assist in the treatment and recovery of many injuries.
How does the procedure work?
A small amount of your blood will be taken from a vein in your arm using a needle and a special syringe. The blood then goes through a rapid spinning process via a centrifuge which separates and also concentrates the platelets and growth factors. This concentrated solution is then delivered to the site of injury through an ultrasound guided injection. The ultrasound is used to make an accurate delivery of the plasma to the damaged area or tissues. The entire procedure usually takes about 20-30 minutes.