Arthritis and Rheumatism Associates, P.C.

Jeffrey Potter, MD, FACR

Arthritis and Rheumatism Associates, PC 

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Intra-Articular Hyaluronic Acid and Topical NSAIDS

Osteoarthritis is the most common form of arthritis and is characterized by pain limited functioning in those patients affected by it. The diagnosis is made using a combination of a patient’s symptoms, physical examination findings and plain film radiographs, or x-rays. Osteoarthritis can occur at any age but is more common in after middle age, and in patients that have previously injured the affected joint or who are overweight. Pain is typically worsened by activity or overuse and relieved by resting; many patients require medications to help relieve their symptoms.

Non-steroidal anti-inflammatories (NSAIDS) are among the first agents used for management of pain related to osteoarthritis. In patients who do not have a satisfactory clinical response to acetaminophen (Tylenol) the use of oral or topical NSAIDs can provide significant relief of symptoms. Examples of commonly used NSAIDs include Advil, Motrin, and Aleve; these are excellent medications for relief of pain and mild inflammation in the appropriate patient population. Patients with underlying kidney disease or significant cardiovascular disease should avoid using NSAIDS, as this can complicate management of these conditions. Patients taking blood thinners, and those who have experienced gastrointestinal bleeding should also avoid using these medications due to increased risk of bleeding. Patients using NSAIDs are often advised to take a proton pump inhibitor or acid blocker to offset stomach upset that can be seen with use of anti-inflammatories. In patients > age 75 use of topical NSAIDS applied directly to the affected joint is preferable, and may limit exposure to possible side effects.

 

 

Use of hyaluronic acid is an alternative pain management strategy for patients with osteoarthritis whose symptoms are incompletely responsive to first line therapies. Also known as “rooster-comb” injections, hyaluronic acid injections are appropriate for patients who have failed therapies such as acetaminophen, non-steroidal anti-inflammatories (NSAIDS), and corticosteroid injections administered directly into the affected joint. Hyaluronic acid is present naturally in the human body and is found most commonly in the eyes and joint fluid. It works as a cushioning and lubricating devices in the joints of those patients affected with osteoarthritis, but is not believed to play a role in reversal of the disease process. Rather it provides often lasting pain relief for patients who have not responded to traditional therapies or who are not ideal candidates for surgical intervention. There are several different available forms of hyaluronic acid; all are administered by injection directly into the affected joint over a course of 1-5 weeks, depending upon the preparation.

In summary, current management of osteoarthritis varies from patient to patient; discussion of available therapies with a rheumatologist will help to alleviate concerns about possible associated side effects from therapy and hopefully lead to treatment and improvement in symptoms. All pharmacologic and non-pharmacologic treatments for osteoarthritis are used in concert with regular physical activity, physical therapy evaluation, and weight loss if indicated. In combination these management strategies should result in decreased discomfort and improved functionality for patients with osteoarthritis.


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