What is arthritis?
The word arthritis literally means "joint inflammation." Arthritis refers to a group of more than 100 diseases and other conditions that cause pain, stiffness, and swelling in joints. Osteoarthritis is a progressive condition that slowly damages the cartilage surrounding the ends of bones and is common in the hip, knee, and spine. Rheumatoid arthritis is a disease that damages the lining surrounding our joints while also destroying our bones, tissue, and joints over time.
How is arthritis treated?
Conservative management of arthritis includes maintaining an ideal body weight for multiple reasons:
- A lower BMI can reduce symptoms and slow the progression of arthritis
- A higher BMI is associated with increased preoperative complications and a dramatic increase in complications with a BMI >40
- Many surgeons will not electively operate on patients with a BMI >40
- Studies DO NOT support patient’s hopes of postoperative weight loss
- Weight trend at surgery is maintained postoperatively (i.e. losing at the time of surgery equates to ongoing weight loss)
- Ideal body weight can open surgical options for less invasive approaches to solving an orthopedic issue (i.e. lower BMI can permit safe utilization of direct anterior approach for total hip replacement)
Additionally, patients should maintain activity and flexibility but avoid activities that aggravate the affected joint:
- Daily activity is better than bursts of activity (i.e. weekend warrior)
- Patients should gradually increase activity as tolerated around an arthritic joint as these joints are more easily aggravated than non-arthritic joints
- Physical therapy can strengthen patients’ stabilizing muscles, improve gait, and reduce pain
- Patients can use a cane, walking stick, trekking pole, or walker to improve balance and gait—these should be used on the OPPOSITE side of the affected extremity
- Patients should try to maintain flexibility, but must be careful as this can aggravate the arthritic joint. With an arthritic hip, in particular, patients should try to maintain their ability to lay flat and stretch out the front of the hip. With an arthritic knee, patients should try to maintain the ability to completely straighten their knee, pushing the back of the knee down onto a bed or the floor.
Other treatments are available, however:
- There has been no solid human evidence for nutritional supplements. Arthritis often waxes and wanes, which is the perfect process for an unproven and expensive supplement to become part of a patient’s routine (i.e. patients have an unrelated benefit after they begin the supplement, and now they can’t stop because they have incorrectly associated this unrelated improvement with the supplement)
- Anti-inflammatory drugs (NSAIDs), when taken regularly and at the recommended dosage for treating inflammation, have an anti-inflammatory effect. Most patients take them sporadically and only gain short-term pain relief
- Tylenol, as well as Tramadol, can be used when NSAIDs are not an option
- Injections can improve symptoms but do not change the course of arthritis. Steroid injections decrease inflammation, swelling, and pain and can be repeated every 3-6 months, but this is physician-specific. Viscosupplementation (Synvisc, Hyalgan, etc.) is the addition of lubrication/nutritional support to the joint. We are seeing a reduction in usage of viscosupplementation, as our orthopedic academy has reduced support for this intervention, secondary to limited support in the literature
- Arthroscopy is not a first line of treatment for an arthritic knee but can be necessary depending on the symptoms. Recent articles do not show the benefit of arthroscopic debridement for a severely arthritic knee, as compared to PT or nonoperative pathways.