The goal of treatment is to relieve pain, stop and delay the progression of the disease, and preserve joint function. The treatment plan should depend on the condition of each patient.
1.General treatment
(1) Patient education Make patients understand the principles of treatment, exercise methods, as well as the use of drugs and adverse effects of the disease.
(2) Physical therapy including heat therapy, hydrotherapy, transcutaneous electrical nerve stimulation therapy, acupuncture, massage and tui-na, traction, etc., all help to reduce pain and relieve joint stiffness.
(3) Reduce joint load and protect joint function The involved joints should avoid excessive load, and patients with knee or hip joint involvement should avoid prolonged standing, kneeling and squatting. Canes and walkers can be used to assist activities, and obese patients should reduce their body weight. Coordinated muscle movement and muscle strength can reduce the painful symptoms of the joint. Therefore, patients should pay attention to strengthen the strength exercise of the muscles around the joint and design exercise programs to maintain the range of motion of the joint.
2.Medication
It can be mainly divided into drugs for symptom control, drugs for improving the condition and chondroprotective agents (Table 4).
(1) Symptom control drugs
(1) Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs are the most commonly used drugs for the treatment of osteoarthritis (Table 4), and their effect is to reduce pain and swelling and improve the movement of joints. The main drugs include diclofenac, etc. Selective cyclooxygenase-2 inhibitors such as rofecoxib, celecoxib and meloxicam are more suitable if the patient is at high risk of NSAIDs-related gastrointestinal adverse reactions. Drug doses should be individualized, and attention should be paid to the effects of other comorbid diseases in elderly patients (see rheumatoid arthritis for specific medications).
Acetaminophen has been shown to be a good pain reliever for osteoarthritis at a low cost. Tramadol is a weak opioid that is well tolerated with little addiction, and the average dose is 200-300 mg daily, but adverse effects should be noted.
(iii) Topical treatment: Topical NSAIDs or intra-articular injections. Glucocorticoid injections into the joint cavity can relieve pain and reduce exudation, and the effect lasts for several weeks to months, but the same joint should not be injected repeatedly (less than 4 times in a year).
Intra-articular injections of hyaluronic acid are effective in reducing joint pain, increasing joint mobility and protecting cartilage, and the therapeutic effect can last for several months.
(2) Improving drugs and chondroprotective agents
These drugs have the effect of reducing the activity of matrix metalloproteinases and collagenases, which can not only anti-inflammatory and analgesic, but also protect joint cartilage, and have the effect of delaying the development of osteoarthritis. The onset of action is generally slow. The main drugs include glucosamine sulfate, glucosaminoglycan, S-adenosylmethionine and doxycycline. Diacerein may also significantly improve patient symptoms, protect cartilage, and improve the course of the disease.
Cartilage damage in osteoarthritis may be related to the action of oxygen free radicals. Recent studies have found that vitamins C, D and E may be beneficial in the treatment of osteoarthritis mainly through their antioxidant mechanism.
3.Surgical treatment
Surgical treatment can be considered for patients with severe lesions and significant joint dysfunction who do not have significant results from medical treatment.
(1) Arthroscopic surgery For patients with significant joint pain and poor response to painkillers and intra-articular glucocorticoid injections, intra-articular lavage can be used to remove fibrin, cartilage debris and other impurities, or remove cartilage fragments through arthroscopy to reduce symptoms.
(2) Orthopedic surgery Osteotomy can improve the balance of joint forces and effectively relieve patients’ hip or knee pain. Patients over 60 years of age with progressive osteoarthritis who do not respond well to regular medication may be offered joint replacement, which can significantly reduce pain symptoms and improve joint function.
In addition, new treatments, such as cartilage transplantation and autologous chondrocyte transplantation, may be used in the treatment of osteoarthritis, but are still under clinical investigation.