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Management of Arthritis and Joint Pain

Management of Arthritis and Joint Pain. Taylor Brown, M.D. Orthopedic Surgery and Sports Medicine. What is Arthritis?. Swollen or painful joint. What is Arthritis?. Loss of the cartilage that covers the ends of each bone Abrasion or wearing away

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Management of Arthritis and Joint Pain

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  1. Management of Arthritis and Joint Pain Taylor Brown, M.D. Orthopedic Surgery and Sports Medicine

  2. What is Arthritis? • Swollen or painful joint

  3. What is Arthritis? • Loss of the cartilage that covers the ends of each bone • Abrasion or wearing away • Inflammation that erodes and irritates the joint

  4. What is Arthritis? • Causes or etiology • Osteoarthritis • Inflammatory arthritis • Crystals = gout or pseudogout • Rheumatoid, lupus, psoriatic • Infectious or post-infectious reactive

  5. Arthritis Symptoms • Pain • Swelling • Stiffness • Loss of function

  6. Arthritis Symptoms • Crunching • Grinding • Giving Way • Instability • Weakness

  7. Arthritis Treatment Goals • Reduce your pain • Improve your function

  8. Arthritis Treatment Goals • There is no validated way to regrow the lost cartilage

  9. Arthritis Treatment Options • Osteoarthritis = wear and tear arthritis

  10. Arthritis Treatment Options • Applicable to all arthritic symptomatic joints • Treatment spectrum • Low risk/reward • Higher risk/reward • You choose what treatment you want

  11. Arthritis Treatment Options • Live with it – no risk, no reward

  12. Arthritis Treatment Options • Activity and Lifestyle modification • if it hurts don’t do it • Weight loss = aquatic programs

  13. Arthritis Treatment Options • Physical Therapy – increased strength and flexibility can decrease your symptoms • Muscles are the shock absorbers for joints

  14. Arthritis Treatment Options • Braces • Soft knee sleeve may decrease pain with warmth and compression • Unloader braces may take pressure off of a single portion of your knee

  15. Arthritis Treatment Options • Cane or Walker – may unload pressure on hip, knee, or ankle joints at the cost of your shoulders

  16. Arthritis Treatment Options • Oral medications • Tylenol • Aspirin • Ibuprofen = advil • Naproxen = aleve

  17. Arthritis Treatment Options • Oral medications • Celecoxib = celebrex • Meloxicam = mobic • Indomethacin • Arthrotec • Lodine • So many more

  18. Arthritis Treatment Options • Oral supplements • Glucosamine • Chondroitin sulfate • MSM • proline • help half the time • None of these will make cartilage grow back, but they may improve your pain and function

  19. Arthritis Treatment Options • Topical remedies • NSAID gel or patch • Voltaren gel • flector patch • ketoprofen cream • Lidocaine patch • lidoderm • OTC • Capsaicin • menthol

  20. Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • viscosupplements

  21. Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • Single injection • Okay for any joint • Pain relief within several days • 3 months typical relief

  22. Arthritis Treatment Options • Injectable therapy • Cortisone = steroids • May accelerate arthritis and cartilage breakdown • Helps 2 of every 3 people • Will increase blood sugar levels for 2 to 3 days in patients with diabetes

  23. Arthritis Treatment Options • Injectable therapy • Viscosupplements • Hyaluronic acid • Viscous liquid • Closely approximates normal joint fluid characteristics • Gone from the knee within days • Effect lasts 6 to 12 months

  24. Arthritis Treatment Options • Injectable therapy • Viscosupplements • Hyaluronic acid • 3 to 5 weekly injections • Only FDA approved for the knee currently • Ongoing studies for shoulder and ankle

  25. Arthritis Treatment Options • Injectable therapy • Viscosupplements • Needs several weeks for effect to be noticed • Most are avian derived • Bacteria derived synthetic product available • Helps 3 of 4 people

  26. Arthritis Treatment Options • Surgical options • Arthroscopic • Joint Replacement = arthroplasty • Osteotomy = realignment

  27. Arthritis Treatment Options • Surgical options • Arthroscopic • Lavage = wash out • Debridement or chondroplasty= clean up and smooth • Microfracture = stimulate with a drill to generate fibrocartilage – not hyaline or articular cartilage • Transplant = auto or allo OATS = rob peter (or donor) to pay paul • Carticel = aci = autologous chondrocyte implantation

  28. Arthritis Treatment Options • Surgical options • Arthroscopic • Lavage = wash out

  29. Arthritis Treatment Options • Surgical options • Arthroscopic • Debridement or abrasion chondroplasty= clean up and smooth

  30. Arthritis Treatment Options • Surgical options • Arthroscopic • Microfracture = stimulate with an awl to generate fibrocartilage – not hyaline or articular cartilage

  31. Arthritis Treatment Options • Surgical options • Arthroscopic • Transplant = auto or allo OATS = rob peter (or cadaver) to pay paul

  32. Arthritis Treatment Options • Surgical options • Arthroscopic combined open • Carticel = aci = autologous chondrocyte implantation • Works well in sweeden

  33. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Use metal or plastic to replace lost cartilage • Open surgery • 3 month recovery • Physical therapy after • 10 to 20 years of relief

  34. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • knee

  35. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • hip

  36. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • shoulder

  37. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Shoulder resurfacing

  38. Arthritis Treatment Options • Surgical options • Joint Replacement = arthroplasty • Biologic shoulder resurfacing

  39. Arthritis Treatment Options • Surgical options • Osteotomy = realignment • Break the leg to remove pressure from the arthritic portion of the knee and place more pressure on the normal portion of the knee

  40. Arthritis Treatment Goals • Reduce your pain • Improve your function • There is no validated way to regrow the lost cartilage

  41. Arthritis Treatment Options • Activity and Lifestyle modification • Physical therapy, braces, canes • Oral medication and supplements • Topical medications • Injectable medications • Surgical options • Arthroscopic • Arthroplasty

  42. Thank YouQuestions?www.bjc-houston.com713-790-1818

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