Options for treatment of Osteoarthritis-Knees

Knee bone

Many studies have been conducted about finding lasting pain relief from osteoarthritis-the number one reason for joint pain; especially in older adults. Medication doesn't always work and they often come with unwanted side effects. It is time to investigate alternative ways to treat this joint pain.

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Introduction
There is a definite lack of curative medical treatment for patients with knee osteoarthritis. Acupuncture represents an important alternative therapy. According to the theory of Chinese medicine patients acupoints and tender points may become sensitized when body suffers from disease state. Osteoarthritis is one of the most prevalent musculoskeletal diseases. It is characterized by gradual loss of joint cartilage and local inflammatory process. This results in a limitation in joint movement, worsening pain, and reduction in quality of life. In the US it often results in early retirement and joint replacement (Tang et al, 2018).

Why is research so important?
In knee osteoarthritis pain sensitization has been linked to a more serious condition buy conservative treatment such as physiotherapy are not established for those with continued sensitivity. This study was conducted to see the correlation between pain sensitivity and non-responsive clinical outcome. Of 134 people in their study after physiotherapy intervention showed poor outcomes in knee osteoarthritis. This included higher temporal summation and lower pressure pain thresholds emerged as robust predicators of non-responsive after physiotherapy along with a higher co-morbidity score. It showed 87.8% had high sensitivity while 52.3% showed modest specificity. Independent relationship between pain sensitivity and non-response may indicate an underlying issue that requires further research (O’Leary et al, 2018).

The usual course of treatment
Numerous strategies exist for the treatment of knee osteoarthritis. They usually start with conservative measures such as anti-inflammatory medications and physiotherapy. Weight loss and exercise are also tried first. If they fail then symptomatic relief is often sought and suggested. Pharmacological may include oral pills, topical or intra-articular methods. Medical devices such as a TENS (trans-cutaneous electrical nerve stimulation) unit, orthotics or knee braces and ultrasound treatments have all been tried. As of the date of this study, a TENS unit has been the most popular treatment. It works by using electrical stimulation to interrupt the nerve impulse from getting to the brain thus reducing the perception of the knee pain. With all the dangerous side effects with the current medications to treat this pain, it seems further research is needed to help eradicate some inconsistencies already noted by other studies (Vannabouathong et al, 2018).
Medial osteoarthritis is a frequent cause of knee pain predominantly affecting patients who have a varus deformity-one that creates bow-leggedness. This study made use of foot-ankle orthotics to help support lateral ankle movement that can affect incorrect pressure on the knee. In addition, the study offered pain medicine and physiotherapy in an effort to treat the complaints of knee pain. The study found the osteoarthritis ankle brace helped and was more apt to be used consistently due to the fact here was very little skin irritation compared to the knee brace. In addition to pain relief an increase in quality of life was reported (Peterson et al, 2018).

And still we have osteoarthritis as a pain source
Chronic knee pain most commonly caused by osteoarthritis is a prevalent condition that is most cases can be effectively treated through conservative non-surgical care involving exercise therapy, education, psychosocial support and weight loss. The problem is most people with chronic knee pain do not receive adequate care suffering in silence. This trial provided strong evidence that a comprehensive 12 week digital care program for chronic knee pain including osteoarthritis yields significantly improved outcomes for pain, physical function, stiffness, surgery risk and understanding of the condition, compared to a control group. Analysis of primary study outcomes demonstrates large improvements in both pain and function scales in treatment group (Mecklenburg et al, 2018).

This study explored the feasibility of enhancing acupuncture treatment of knee osteoarthritis using well tested methods. The results showed acupuncture is useful in either stopping the pain or decreasing it enough to increase the patients’ quality of life. The first time the researchers found that boosted expectations of pain relief due to active treatment can be transferred to chronic knee pain to enhance clinical outcomes. Knee osteoarthritis is a major age-related public health problem and leading cause of long-term pain and disability. Medicinal treatment for knee osteoarthritis, often come with unwanted side effects. Acupuncture has been seen as a promising treatment option for knee osteoarthritis. After contacting all subjects who had received acupunctures, their positive response to the researchers was associated with clinical improvements after just six treatments showing its benefits (Kong et al, 2018).

Conclusion
Osteoarthritis is the most common type of arthritis and is a major cause of morbidity, activity limitation, physical disability, excess health care utilization and reduced-health and reduced quality of life. Management of osteoarthritis uses a combination of pharmaceuticals and non-pharmaceuticals in an effort to treat the pain experienced with movement. Many studies have been conducted showing the safety of chondroitin sulfate. For those who don’t know what chondroitin is, it is a polysaccharide that is soluble in water. It is collected from raw cartilage such as bovine, porcine, and avian. It is used in gels and hydrogels for the treatment of osteoarthritis. This study while limited by the total number of participants, did show that an oral treatment with chondroitin sulfate was not only tolerable but in doses greater than 1560 per day was found to be effective for patients with knee osteoarthritis (Morita et al, 2018)

In 1955, intra-articular injections of corticosteroids was reported to be effective in 80% of arthritic joints. But the pain relief didn’t last so more potent synthetic corticosteroids gradually replaced hydrocortisone for intra-articular treatment. Osteoarthritis pain represents a major health problem for gaining and increasingly obese populations. A new discovery called FX006 that has led to a much longer period of time free of pain up to 12 weeks. It was significant for lasting more than 12 weeks and showed improvement in the damage done. This provides a starting place for further research (Conaghan et al, 2018).

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Works Cited
Conaghan, P.G. et al. (2018). Effects of single Intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain. The Journal of Bone and Joint Surgery Inc, 100(8).

Kong, J. et al. (2018). Enhancing treatment of osteoarthritic knee pain by boosting expectancy: A functional neuroimaging study. NeuroImage: Clinical.

Mecklenburg, G. et al. (2018). Effects of a 12 week digital care program from chronic knee pain on pain, mobility and surgery risk: Randomized controlled trial. Journal of Medical Internet Research, 20(4).

Morita, M. et al. (2018). Efficacy of chondroitin sulfate for painful knee osteoarthritis: A one-year randomized double-blind multi-center clinical study in Japan. Biological and Pharmaceutical Bulletin, 41(2).

O’Leary, H. et al. (2018). Pain sensitization associated with nonresponsive after physiotherapy in people with knee osteoarthritis. The Journal of the International Association of the Study of Pain, 159(9).

Peterson, W. et al. (2018).Non-operative treatment of unicompartmental osteoarthritis of the knee: A prospective randomized trial with two different braces ankle-foot orthotic versus knew unloader brace. Archives of Orthopedic and Trauma Surgery.

Tang, L. et al. (2018). Acupuncture treatment for knee osteoarthritis with sensitive points: Protocol for a multicenter randomized controlled trial. BMJ Journals Complementary Medicine.

Vannabouathong, C. et al. (2018). Non-operative treatment for knee osteoarthritis: An evaluation of treatment characteristics and intra-articular placebo effect: A systemic review. Journal of Bone and Joint Surgery,6(7).

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