Osteoarthritis

Knee – One of the most common locations for osteoarthritis and a frequent cause of pain with walking, stairs, running and recreational activity.

Hip – Hip OA may cause pain in the groin, thigh or buttock and can progressively limit walking and hip mobility.

Hands and thumbs – Particularly the base of the thumb and the small joints of the fingers.

Spine – Degenerative changes commonly occur in the cervical and lumbar spine.

Shoulder – Arthritis can affect the main glenohumeral joint or the smaller acromioclavicular (AC) joint.

Ankle and foot – Ankle arthritis is less common than knee or hip OA and frequently develops following a previous injury.

For the most part medical therapy should be considered before surgery or joint replacement. Although joint replacement can provide significant relief, surgeries have a higher complication, profile than medical therapy.

There is no single treatment that is appropriate for everyone. Management is usually individualized according to the joint involved, severity of symptoms, activity goals, other medical conditions and previous treatments.

Treatment may include education, activity modification, exercise and strengthening, physiotherapy, weight management when appropriate, braces or supports, topical or oral medications, and joint injections.

For people who remain symptomatic despite conservative treatment, injections can sometimes provide meaningful pain relief and allow improved participation in rehabilitation and physical activity.

Several oral medication’s are currently available, both over-the-counter and through prescription that provide symptomatic relief of osteoarthritis.

Oral medications can help reduce pain and improve function in osteoarthritis (OA), but they do not restore cartilage or cure the condition. Medication choice depends on symptom severity and individual medical risks.

Acetaminophen (Tylenol): May provide modest relief for mild OA pain and can be useful when anti-inflammatory medications are unsuitable. Excessive dosing can cause liver injury.

NSAIDs: Medications such as ibuprofen, naproxen and diclofenac are among the most effective oral treatments for OA pain and inflammation. They can affect the stomach, kidneys, blood pressure and cardiovascular system, so the lowest effective dose is generally preferred.

COX-2 Selective NSAIDs: Celecoxib (Celebrex) provides pain and anti-inflammatory effects similar to traditional NSAIDs, generally with less upper gastrointestinal toxicity. Kidney, blood-pressure and cardiovascular risks still require consideration.

Duloxetine (Cymbalta): A pain-modulating medication that can help chronic OA pain, particularly knee OA. It may be considered when NSAIDs are ineffective, contraindicated or poorly tolerated.

Gabapentin: Not a routine treatment for OA, but may occasionally be considered when pain has a significant nerve-related or sensitized component, such as burning, shooting or electric-type pain. Evidence for typical OA pain is limited.

Opioids: Generally avoided for routine OA management because long-term benefit is limited and risks include sedation, falls, tolerance, dependence and overdose. They are usually reserved for selected circumstances.

Glucosamine & Chondroitin: Widely used supplements, but research results are inconsistent and they have not been reliably shown to slow or reverse osteoarthritis.

Several types of injections may be considered for osteoarthritis. They work in different ways, and the most appropriate option depends on the joint involved, severity of arthritis, symptoms, previous treatments and your individual goals.

Corticosteroid Injections

Corticosteroids are anti-inflammatory medications injected directly into the affected joint.

They can provide relatively rapid pain relief, particularly when there is significant inflammation or swelling. The benefit is generally temporary and varies between individuals.

Corticosteroid injections can be useful for an acute flare of osteoarthritis. Repeated injections should be considered carefully because of potential effects on cartilage and other joint tissues.

Hyaluronic Acid Injections

Hyaluronic acid—also known as viscosupplementation—is injected into the joint to supplement the naturally occurring hyaluronic acid found within synovial fluid.

Hyaluronic acid contributes to the lubricating and shock-absorbing properties of joint fluid. Injections are used most commonly for knee osteoarthritis, although they may be considered for selected other joints.

Some patients experience improvement in pain and function lasting several months, while others experience little or no benefit.

Different formulations are available, including single-injection and multiple-injection treatments. Examples include Monovisc®, Synvisc® and other hyaluronic-acid preparations.

Platelet-Rich Plasma (PRP)

PRP is an orthobiologic treatment prepared from your own blood.

A small blood sample is collected and processed to concentrate platelets and associated growth factors. The resulting platelet-rich plasma is then injected into the affected joint.

PRP has been studied particularly extensively in knee osteoarthritis. Evidence suggests that appropriately selected patients—particularly those with mild to moderate knee OA—may experience improvement in pain and function.

PRP preparation methods differ, so platelet concentration and the number of white blood cells within the preparation can vary between systems.

Arthrosamid® – Polyacrylamide Hydrogel

Arthrosamid® is a new and promising injection for knee osteoarthritis, recently approved by Health Canada. It is a non-biodegradable injectable polyacrylamide hydrogel (iPAAG) used for the treatment of knee osteoarthritis. It has been used in Canada for a number of years for urinary incontinence and females. It has a proven safety profile.

Unlike corticosteroid, hyaluronic acid or PRP injections, Arthrosamid is designed to remain within the joint. Following injection, the hydrogel becomes integrated with the synovial tissue lining the joint and is intended to provide a cushioning effect and modify the joint environment.

Arthrosamid is administered as a single intra-articular injection and is intended to provide longer-lasting improvement in osteoarthritis symptoms.

Clinical studies have demonstrated improvements in pain and function in some patients with knee osteoarthritis, with benefits reported for several years following a single treatment. As with other osteoarthritis treatments, individual responses vary and not everyone will experience significant improvement.

Arthrosamid is currently used primarily for knee osteoarthritis. Appropriate patient selection and careful sterile injection technique are important because the material is designed to remain permanently within the joint.

There is no single injection that is best for everyone.

Treatment may include corticosteroid, hyaluronic acid, PRP, Arthrosamid or selected combination therapies, depending on the individual situation.

The choice should take into consideration:

• The joint involved
• Severity of osteoarthritis
• Presence of inflammation or swelling
• Age and activity level
• Previous injuries or surgery
• Previous response to injections
• Other medical conditions and medications
• Your goals for work, exercise, recreation and sport

A sports medicine assessment can help determine whether an injection is appropriate and which treatment offers the most appropriate balance of evidence, potential benefit and risk for you.