Csteoarthr|t|s

Csteoarthr|t|s (CA) also known as degeneraLlve arLhrlLls or degeneraLlve [olnL dlsease ls a group of mechanlcal
abnormallLles lnvolvlng degradaLlon of [olnLs lncludlng arLlcular carLllage and subchondral bone SympLoms may
lnclude [olnL paln Lenderness sLlffness locklng and someLlmes an effuslon A varleLy of causesheredlLary
developmenLal meLabollc and mechanlcalmay lnlLlaLe processes leadlng Lo loss of carLllage When bone
surfaces become less well proLecLed by carLllage bone may be exposed and damaged As a resulL of decreased
movemenL secondary Lo paln reglonal muscles may aLrophy and llgamenLs may become more lax

1reaLmenL generally lnvolves a comblnaLlon of exerclse llfesLyle modlflcaLlon and analgeslcs lf paln becomes
deblllLaLlng [olnL replacemenL surgery may be used Lo lmprove Lhe quallLy of llfe CA ls Lhe mosL common form of
arLhrlLls and Lhe leadlng cause of chronlc dlsablllLy ln Lhe unlLed SLaLes lL affecLs abouL 8 mllllon people ln Lhe
unlLed klngdom and nearly 27 mllllon people ln Lhe unlLed SLaLes


Causes

Lxerclse lncludlng runnlng ln Lhe absence of ln[ury has noL been found Lo lncrease ones rlsk of developlng
osLeoarLhrlLls Some lnvesLlgaLors belleve LhaL mechanlcal sLress on [olnLs underlles all osLeoarLhrlLls wlLh many
and varled sources of mechanlcal sLress lncludlng mlsallgnmenLs of bones caused by congenlLal or paLhogenlc
causes mechanlcal ln[ury overwelghL loss of sLrengLh ln muscles supporLlng [olnLs and lmpalrmenL of perlpheral
nerves leadlng Lo sudden or uncoordlnaLed movemenLs LhaL oversLress [olnLs

r|mary
rlmary osLeoarLhrlLls of Lhe lefL knee noLe Lhe osLeophyLes narrowlng of Lhe [olnL space (arrow) and lncreased
subchondral bone denslLy (arrow)

1hls Lype of CA ls a chronlc degeneraLlve dlsorder relaLed Lo buL noL caused by aglng as Lhere are people well lnLo
Lhelr nlneLles who have no cllnlcal or funcLlonal slgns of Lhe dlsease As a person ages Lhe waLer conLenL of Lhe
carLllage decreases as a resulL of a reduced proLeoglycan conLenL Lhus causlng Lhe carLllage Lo be less reslllenL
WlLhouL Lhe proLecLlve effecLs of Lhe proLeoglycans Lhe collagen flbers of Lhe carLllage can become suscepLlble Lo
degradaLlon and Lhus exacerbaLe Lhe degeneraLlon lnflammaLlon of Lhe surroundlng [olnL capsule can also occur
Lhough ofLen mlld (compared Lo LhaL whlch occurs ln rheumaLold arLhrlLls) 1hls can happen as breakdown
producLs from Lhe carLllage are released lnLo Lhe synovlal space and Lhe cells llnlng Lhe [olnL aLLempL Lo remove
Lhem new bone ouLgrowLhs called spurs or osLeophyLes can form on Lhe marglns of Lhe [olnLs posslbly ln an
aLLempL Lo lmprove Lhe congruence of Lhe arLlcular carLllage surfaces 1hese bone changes LogeLher wlLh Lhe
lnflammaLlon can be boLh palnful and deblllLaLlng

A number of sLudles have shown LhaL Lhere ls a greaLer prevalence of Lhe dlsease beLween slbllngs and especlally
ldenLlcal Lwlns lndlcaLlng a heredlLary basls up Lo 60 of CA cases are LhoughL Lo resulL from geneLlc facLors

8oLh prlmary generallzed nodal CA and eroslve CA (LCA also called lnflammaLory CA) are subseLs of prlmary CA
LCA ls a much less common and more aggresslve lnflammaLory form of CA whlch ofLen affecLs Lhe uls and has
characLerlsLlc changes on x8ay

Secondary
1hls Lype of CA ls caused by oLher facLors buL Lhe resulLlng paLhology ls Lhe same as for prlmary CA

* CongenlLal dlsorders of [olnLs
* ulabeLes
* lnflammaLory dlseases (such as erLhes dlsease) (Lyme dlsease) and all chronlc forms of arLhrlLls (eg
cosLochondrlLls gouL and rheumaLold arLhrlLls) ln gouL urlc acld crysLals cause Lhe carLllage Lo degeneraLe aL a
fasLer pace
* ln[ury Lo [olnLs as a resulL of an accldenL or orLhodonLlc operaLlons
* SepLlc arLhrlLls (lnfecLlon of a [olnL )
* LlgamenLous deLerloraLlon or lnsLablllLy may be a facLor
* Marfan syndrome
* CbeslLy
* AlkapLonurla
* PemochromaLosls and Wllsons dlsease


S|gns and symptoms

1he maln sympLom ls paln causlng loss of ablllLy and ofLen sLlffness aln ls generally descrlbed as a sharp ache
or a burnlng sensaLlon ln Lhe assoclaLe muscles and Lendons CA can cause a crackllng nolse (called creplLus)
when Lhe affecLed [olnL ls moved or Louched and paLlenLs may experlence muscle spasm and conLracLlons ln Lhe
Lendons Cccaslonally Lhe [olnLs may also be fllled wlLh fluld Pumld and cold weaLher lncreases Lhe paln ln many
paLlenLs

CA commonly affecLs Lhe hands feeL splne and Lhe large welghL bearlng [olnLs such as Lhe hlps and knees
alLhough ln Lheory any [olnL ln Lhe body can be affecLed As CA progresses Lhe affecLed [olnLs appear larger are
sLlff and palnful and usually feel worse Lhe more Lhey are used LhroughouL Lhe day Lhus dlsLlngulshlng lL from
rheumaLold arLhrlLls

ln smaller [olnLs such as aL Lhe flngers hard bony enlargemenLs called Peberdens nodes (on Lhe dlsLal
lnLerphalangeal [olnLs) and/or 8ouchards nodes (on Lhe proxlmal lnLerphalangeal [olnLs) may form and Lhough
Lhey are noL necessarlly palnful Lhey do llmlL Lhe movemenL of Lhe flngers slgnlflcanLly CA aL Lhe Loes leads Lo Lhe
formaLlon of bunlons renderlng Lhem red or swollen Some people noLlce Lhese physlcal changes before Lhey
experlence any paln

CA ls Lhe mosL common cause of [olnL effuslon someLlmes called waLer on Lhe knee ln lay Lerms an accumulaLlon
of excess fluld ln or around Lhe knee [olnL
Source hLLp//enwlklpedlaorg/wlkl/CsLeoarLhrlLls



Nurs|ng Care |an for Csteoarthr|t|s


Nurs|ng Assessment for Csteoarthr|t|s

- AcLlvlLy / 8esL
- !olnL paln due Lo movemenL Lenderness worsened by sLress on Lhe [olnLs sLlffness ln Lhe mornlng usually occurs
bllaLerally and symmeLrlcally funcLlonal llmlLaLlons LhaL affecL llfesLyle lelsure work faLlgue malalse
- LlmlLaLlon of movemenL muscle aLrophy skln conLracLor / abnormallLles ln Lhe [olnLs and muscles
- Cardlovascular
- 8aynauds phenomenon of Lhe hand (eg llLermlLen pale cyanosls and redness on Lhe flngers before Lhe color
reLurned Lo normal
- Lgo lnLegrlLy
- SLress facLors of acuLe / chronlc (eg flnanclal [obs dlsablllLy relaLlonshlp facLors
- Popelessness and helplessness (lnablllLy slLuaLlon)
- 1hreaLs Lo Lhe selfconcepL body lmage personal ldenLlLy for example dependence on oLhers
- lood / llulds
- 1he lnablllLy Lo produce or consume food or llqulds adequaLely nausea anorexla
- ulfflculLy chewlng welghL loss dryness of mucous membranes
- Pyglene
- 1he dlfflculLles Lo lmplemenL selfcare acLlvlLles dependence on oLhers
- neurosensory
- 1lngllng ln hands and feeL swollen [olnLs
- aln / comforL
- 1he acuLe phase of paln (probably noL accompanled by sofL Llssue swelllng ln Lhe [olnLs chronlc paln and sLlffness
(especlally ln Lhe mornlng)
- SecurlLy
- Skln shlny LauL nodules sub mlLaneus
- Skln leslons fooL ulcers
- 1he dlfflculLy ln handllng Lhe Lask / household malnLenance
- Mlld fever seLLled
- uryness ln Lhe eyes and mucous membranes
- Soclal lnLeracLlon
- uamage lnLeracLlon wlLh famlly or oLhers Lhe changlng role lsolaLlon
- Counsellng / Learnlng
- lamlly hlsLory of rheumaLlc
- 1he use of healLh foods vlLamlns cure dlsease wlLhouL LesLlng
- PlsLory perlcardlLls valve leslon edge ulmonary flbrosls pleurlLls

Nurs|ng D|agnos|s for Csteoarthr|t|s

- aln AcuLe / Chronlc relaLed Lo dlsLenLlon of Llssue by Lhe accumulaLlon of fluld / lnflammaLory process Llquor
[olnLs
- lmpalred hyslcal MoblllLy relaLed Lo skeleLal deformlLles paln dlscomforL decreased muscle sLrengLh

Nurs|ng D|agnos|s and Nurs|ng Intervent|on for Csteoarthr|t|s

1 aln AcuLe / Chronlc relaLed Lo dlsLenLlon of Llssue by Lhe accumulaLlon of fluld / lnflammaLory process Llquor
[olnLs

LxpecLed CuLcomes

- Showlng paln ls reduced or conLrolled
- Looks relaxed Lo resL sleep and parLlclpaLe ln acLlvlLles based on ablllLy
- lollowlng Lhe Lherapy program
- uslng Lhe skllls of relaxaLlon and enLerLalnmenL acLlvlLy ln Lhe paln conLrol program
nurslng lnLervenLlon

- Assess paln noLe Lhe locaLlon and lnLenslLy of paln (scale 010) WrlLe down Lhe facLors LhaL acceleraLe and slgns
of nonverbal paln
- Clve Lhe hard maLLress small plllow LlevaLe bed when a cllenL needs Lo resL / sleep
- Pelp Lhe cllenL Lake a comforLable poslLlon when sleeplng or slLLlng ln a chalr uepLh of bed resL as lndlcaLed
- MonlLor Lhe use of a plllow
- Pelp cllenLs Lo frequenLly change poslLlons
- Pelp Lhe cllenL Lo a warm baLh aL Lhe Llme of waklng
Pelp Lhe cllenL Lo a warm compress on Lhe sore [olnLs several Llmes a day
- MonlLor LemperaLure compress
Clve a massageLncourage Lhe use of sLress managemenL Lechnlques such as progresslve relaxaLlon blofeedback
LherapeuLlc Louch vlsuallzaLlon self hypnosls guldellnes lmaglnaLlon and breaLh conLrolLngage ln acLlvlLles of
enLerLalnmenL LhaL ls sulLable for lndlvldual slLuaLlons
- Clve Lhe drug before acLlvlLy / exerclse LhaL ls planned as dlrecLed
- AsslsL cllenLs wlLh physlcal Lherapy

2 lmpalred hyslcal MoblllLy relaLed Lo skeleLal deformlLles paln dlscomforL decreased muscle sLrengLh

LxpecLed CuLcomes

MalnLaln or lmprove sLrengLh and funcLlon of Lhe compensaLlon parL of Lhe body

uemonsLraLlng Lechnlques / behavlors LhaL allow dolng acLlvlLles

nurslng lnLervenLlon


- MonlLor Lhe level of lnflammaLlon / paln ln [olnLs
- MalnLaln bed resL / slL lf necessary
- Schedule of acLlvlLles Lo provlde a resL perlod of conLlnuous and unlnLerrupLed nlghLLlme sleep
- AsslsL cllenLs wlLh range of moLlon acLlve / passlve and reslsLlve exerclse and lsomeLrlc lf posslble
- Sllde Lo malnLaln an uprlghL poslLlon and slLLlng helghL sLandlng and walklng
- rovlde a safe envlronmenL for example ralse Lhe chalr / LolleL use a hlgh grlp and Lub and LolleL Lhe use of
moblllLy alds / wheelchalrs rescue
- CollaboraLlon physlcal LheraplsL / occupaLlonal and speclallsL vaslonal


Nurs|ng D|agnos|s (ostoperat|ve)
- Acote polo teloteJ to sotqlcol loclsloo
- lsk fot lofectloo teloteJ to Jlstoptloo lo sklo loteqtlty
- polteJ pbyslcol oblllty teloteJ to octlvlty ooJ welqbtbeotloq
testtlctloos
- lsk fot loeffectlve tlssoe petfosloo tlqbt leq teloteJ to voscolot
Jlstoptloo ooJ eJeo
epected Cutcomes
- ,olotolo oo oJepoote level of cofott postopetotlvely os JeoosttoteJ by
- @be oblllty to ove eoslly wltblo testtlctloos
- opllooce wltb losttoctloos to cooqb ooJ bteotbe Jeeply
- Ietbol exptessloos of cofott
- eolo ftee of oJvetse coosepoeoces of loblllty socb os poeooolo ptessote oteos tbtoboebolls ot
coottoctote
- eolo ftee of lofectloo
- ,olotolo oJepoote petfosloo of offecteJ leq
- eolo ftee of lojoty postopetotlvely
Nurs|ng Intervent|on
- Assess polo ot leost bootly Jotloq fltst 24 to 48 boots postopetotlvely ooJ os oeeJeJ tbeteoftet
- osttoct lo tbe ose of potleotcoottolleJ ooolqeslo (lA) ooJ ooltot lts effectlveoess
- elp cbooqe posltloo ot leost evety 2 boots eocootoqe tbe ose of tbe ovetbeoJ ttopeze to sblft posltloos ftepoeotly
- ,olotolo sepoeotlol coptessloo Jevlce ooJ ootlebollc stockloq os otJeteJ teove fot 1 boot Jolly
- ocootoqe tbe ose of tbe loceotlve spltoetet bootly fot fltst 24 boots tbeo ot leost evety 2 boots wblle owoke
- Asslst oot of beJ tbtee tles o Joy oftet tbe fltst 24 boots
- ,olotolo obJoctloo of tbe tlqbt blp wltb plllows
- letfot posslve , exetclses of oooffecteJ extteltles evety sblft
- ocootoqe ftepoeot pooJtlcepssettloq exetclses ooJ plootot ooJ Jotslflexloo of feet
- Assess tbe sotqlcol slte ftepoeotly tepott slqos of excess bleeJloq ot loflootloo
- ,ooltot tepetotote evety 4 boots
- Assess polses colot oveeot ooJ seosotloo of tlqbt foot bootly fot tbe fltst 24 boots tbeo evety 2 boots fot 24
boots tbeo evety 4 boots

nonpharmacologlcal LreaLmenL
LducaLlon (paLlenL and spouse or famlly)

Soclal supporL (Lelephone conLacL)

hysloLherapy (aeroblc exerclses muscle sLrengLhenlng and paLellar sLrapplng)

CccupaLlonal Lherapy (alds and appllances [olnL proLecLlon)

WelghL loss

AcupuncLure

1ranscuLaneous elecLrlcal nerve sLlmulaLlon (1LnS)

harmacologlcal LreaLmenL
Slmple analgesla

nonsLeroldal anLllnflammaLory drugs

CCx2 lnhlblLors (cyclooxygenase2 selecLlve nonsLeroldal anLllnflammaLory drugs)

1oplcal (nonsLeroldal anLllnflammaLory drugs capsalcln)

ChondroproLecLlve agenLs

lnLraarLlcular LreaLmenL
CorLlcosLerolds

Pyaluronans

1ldal lrrlgaLlon

MedlcaLlons

AceLamlnophen AceLamlnophen (1ylenol oLhers) can relleve paln buL doesnL reduce lnflammaLlon lL has been
shown Lo be effecLlve for people wlLh osLeoarLhrlLls who have mlld Lo moderaLe paln 1aklng more Lhan Lhe
recommended dosage of aceLamlnophen can cause llver damage
CS1LCA81P8l1lS 18LA1MLn1 Wl1PCu1 MLulCA1lCnS

1here are a number of LreaLmenLs oLher Lhan medlcaLlons 1hese can subsLanLlally lmprove your arLhrlLls
sympLoms and Lhey are usually Lhe flrsL arLhrlLls LreaLmenLs recommended

esL ArLhrlLls sympLoms are Lyplcally worsened by acLlvlLy and lmproved wlLh resL Powever a compleLe lack of
acLlvlLy can lead Lo a loss of muscle and [olnL sLlffness lf arLhrlLls flares and causes slgnlflcanL paln and
lnflammaLlon your healLhcare provlder may recommend resL for 12 Lo 24 hours followed by a reLurn Lo usual
acLlvlLles

We|ght |oss CbeslLy ls sLrongly llnked Lo Lhe developmenL of arLhrlLls of Lhe knee WelghL loss even modesL
welghL loss appears Lo lower Lhls rlsk lL ls noL yeL known lf welghL loss slows Lhe worsenlng of arLhrlLls ln [olnLs
LhaL are already affecLed Powever welghL loss may reduce [olnL paln from welghLbearlng [olnLs such as Lhe hlps
and knees (See aLlenL lnformaLlon WelghL loss LreaLmenLs)

hys|ca| therapy and eerc|se programs hyslcal Lherapy and exerclse lmprove flexlblllLy and sLrengLhen Lhe
muscles surroundlng Lhe [olnLs eople who exerclse regularly desplLe Lhelr arLhrlLls wlll Lyplcally have less paln
and beLLer funcLlon Lhan Lhose who are lnacLlve A separaLe arLlcle dlscusses exerclse and arLhrlLls (See aLlenL
lnformaLlon ArLhrlLls and exerclse)

Crthoses CrLhoses are devlces LhaL help Lo keep Lhe [olnLs allgned and funcLlonlng correcLly 1here are many
dlfferenL Lypes of orLhoses LhaL can reduce sympLoms and help malnLaln funcLlon ln people wlLh osLeoarLhrlLls

Wellcushloned shoes and orLhoLlc shoe lnserLs may reduce sLress on Lhe [olnLs of Lhe splne and leg
SpllnLs LhaL lmmoblllze Lhe [olnLs can reduce paln and lnflammaLlon and many spllnLs can be worn LhroughouL Lhe
day and nlghL 8races can help sLablllze unsLable [olnLs
AsslsLlve devlces Canes walkers elecLrlc powered seaL llfLs ralsed LolleL seaLs and Lub and shower bars can
reduce Lhe sLress on [olnLs and make lL easler Lo perform dally Lasks A physlcal LheraplsL may suggesL Lhese and
oLher asslsLlve devlces dependlng upon Lhe severlLy and locaLlon of your arLhrlLls

vlLamlns SLudles have llnked cerLaln vlLamlns Lo [olnL healLh buL Lhe role of vlLamlns ln arLhrlLls LreaLmenL ls sLlll
uncerLaln CsLeoarLhrlLls ls less llkely Lo worsen ln people who have a hlgh dleLary lnLake of vlLamln C (ascorblc
acld) and a hlgh dleLary lnLake and hlgh blood levels of vlLamln u Powever lL ls unknown lf supplemenLaLlon wlLh
Lhese vlLamlns has Lhe same effecLs or lf hlgh dleLary lnLakes of vlLamlns can prevenL Lhe onseL of osLeoarLhrlLls
(See aLlenL lnformaLlon Calclum and vlLamln u for bone healLh)

PeaL and cold Lheraples Applylng heaL and cold Lo arLhrlLlc [olnLs can help Lo conLrol arLhrlLls sympLoms such as
paln and sLlffness

neat therapy PeaL relleves paln and sLlffness ln arLhrlLlc [olnLs PeaL can be applled Lo Lhe [olnLs wlLh hoL packs
hoL waLer boLLles heaLlng pads or elecLrlcally heaLed mlLLens
lL ls lmporLanL Lo avold burnlng Lhe skln wlLh heaL Lherapy 1o avold burns hoL waLer boLLles should be fllled wlLh
warm noL bolllng waLer PeaLlng pads should be seL on a Llmer and used for no more Lhan 20 mlnuLes aL a Llme
1he heaLlng pad can be reapplled afLer 20 mlnuLes of no use

Cold Lherapy Cold relleves paln ln arLhrlLlc [olnLs and reduces muscle spasms Cold can be applled for shorL
perlods uslng lce packs or coolanL sprays eople wlLh cerLaln medlcal condlLlons such as Lhe 8aynaud
phenomenon should noL use cold Lherapy
1ranscuLaneous elecLrlcal nerve sLlmulaLlon (1LnS) A 1LnS unlL dellvers a mlld elecLrlcal currenL Lo Lhe skln
sLlmulaLlng nerve flbers ln Lhe skln LhaL may lnLerfere wlLh Lhe Lransmlsslon of paln slgnals from Lhe arLhrlLlc [olnL

1he use of 1LnS as an arLhrlLls LreaLmenL ls conLroverslal Some sLudles have found LhaL Lhose who use 1LnS for
arLhrlLls of Lhe knee have reduced knee paln a greaLer ablllLy Lo bend Lhe knee and a reduced duraLlon of mornlng
sLlffness Powever anoLher sLudy found LhaL 1LnS was no more effecLlve for rellevlng paln Lhan Lhe drug naproxen
(Aleve Anaprox) or a placebo

ArLhrlLls educaLlon and supporL Chronlc arLhrlLls can be hard boLh physlcally and psychologlcally ArLhrlLls
sympLoms may cause you Lo feel frusLraLed dependenL upon oLhers for help and even depressed 1hese facLors
may reduce your moLlvaLlon Lo sLlck wlLh arLhrlLls LreaLmenL

8y learnlng more abouL osLeoarLhrlLls you can beLLer parLlclpaLe ln your own care lL ls lmporLanL Lo dlscuss Lhe
opLlons for Lhe LreaLmenL of arLhrlLls Lhe effecLs of arLhrlLls on dally acLlvlLles and sLraLegles for coplng wlLh Lhe
llmlLaLlons lmposed by arLhrlLls wlLh your healLhcare provlder

Some sLudles suggesL LhaL psychosoclal supporL may be as effecLlve as drug Lherapy for reduclng Lhe sympLoms of
arLhrlLls SupporL can be achleved by bulldlng an lnformal supporL neLwork or by parLlclpaLlng ln formal arLhrlLls
supporL group lnformaLlon abouL Lhese groups ls avallable below (see Where Lo geL more lnformaLlon below)

CLher Lheraples Several oLher Lheraples have been evaluaLed Lo deLermlne lf Lhey have any effecL on
osLeoarLhrlLls (See lnvesLlgaLlonal approaches Lo Lhe pharmacologlc Lherapy of osLeoarLhrlLls)

D|etary supp|ements Clucosamlne and chondrolLln are dleLary supplemenLs LhaL have recelved a loL of
aLLenLlon for Lhelr poLenLlal beneflL ln reduclng paln and slowlng Lhe progresslon of arLhrlLls

G|ucosam|ne Clucosamlne PCL was no more effecLlve ln rellevlng arLhrlLls paln or lmprovlng funcLlon Lhan
placebo ln a well deslgned conLrolled Lrlal lL ls posslble LhaL oLher formulaLlons may be effecLlve Clucosamlne
does noL appear Lo slow Lhe worsenlng of arLhrlLls over Lhe long Lerm 1 1here are few slde effecLs of
glucosamlne lL should noL be used by paLlenLs who are allerglc Lo shellflsh
ChondrolLln ChondrolLln used alone appears Lo provlde llLLle beneflL for people wlLh osLeoarLhrlLls 1here are no
slgnlflcanL slde effecLs of chondrolLln
1he comblnaLlon of glucosamlne and chondrolLln sulfaLe has noL proven Lo be beLLer Lhan placebo for paln rellef or
funcLlonal lmprovemenL ln paLlenLs wlLh CA of Lhe knee 2

1rad|t|ona| Ch|nese med|c|ne Several componenLs of LradlLlonal Chlnese medlclne lncludlng herbs and
acupuncLure may help conLrol Lhe arLhrlLls sympLoms ln some people alLhough Lhe beneflLs of Lhese Lheraples
have noL been conflrmed ln large well deslgned cllnlcal sLudles

8eumalex wlllow bark sLlnglng neLLle ArLlculln l devlls claw exLracL of soybean and avocado unsaponlflables
(ASu) and hyLodolor may lmprove arLhrlLls paln whlle oLher herbs and comblnaLlons such as Lazmov ClLadyl or
glnger exLracL are probably lneffecLlve lf you are conslderlng uslng herbal medlclnes Lalk Lo your healLhcare
provlder

Capsalcln cream Some people experlence rellef of arLhrlLls paln when Lhey apply creams conLalnlng capsalcln
Lhe acLlve subsLance ln hoL chlll peppers Capsalcln depleLes a palncauslng subsLance ln nerve endlngs and lessens
Lhe arLhrlLls paln by abouL 30 percenL ln some people lorLy percenL of people experlence slde effecLs when uslng
capsalcln cream lncludlng burnlng sLlnglng and redness of Lhe skln

Applylng subsLances such as dlmeLhylsulfoxlde (uMSC) or uslng low power laser llghL copper braceleLs or
magneLs are of quesLlonable beneflL ChlropracLlc manlpulaLlon acupressure blofeedback and homeopaLhy are
popular buL also have unproven beneflLs for arLhrlLls sympLoms

CS1LCA81P8l1lS 18LA1MLn1 Wl1P MLulCA1lCnS

urug Lherapy ls a key componenL of an arLhrlLls LreaLmenL plan Many Lypes of drugs are avallable More deLalled
lnformaLlon ls avallable separaLely (See harmacologlc Lherapy of osLeoarLhrlLls)

a|n re||ef med|cat|ons Analgeslcs relleve paln buL do noL have any effecL on lnflammaLlon 1hese drugs are
ofLen recommended when arLhrlLls paln does noL respond Lo nonpharmacologlc measures urugs ln Lhls class
lnclude aceLamlnophen and oplold (narcoLlc) analgeslcs

Acetam|nophen (1y|eno| and others) can relleve mlld Lo moderaLe arLhrlLls paln 1o avold Lhe serlous buL rare
slde effecL of llver damage due Lo aceLamlnophen lL ls lmporLanL Lo follow doslng lnsLrucLlons and avold drlnklng
excesslve amounLs of alcohol

1he paln of sudden severe arLhrlLls exacerbaLlons may requlre LreaLmenL wlLh narcoLlc analgeslcs such as codelne
narcoLlcs should be Laken for only shorL perlods of Llme because Lhey can be addlcLlve 1hey are ofLen mosL
effecLlve when Laken LogeLher wlLh nonsLeroldal anLllnflammaLory drugs (nSAlus) narcoLlcs can also be
comblned wlLh aceLamlnophen (eg 1ylenol 3 conLalns aceLamlnophencodelne)

Nonstero|da| ant||nf|ammatory drugs nonsLeroldal anLllnflammaLory drugs (nSAlus) relleve paln and reduce
lnflammaLlon Many of Lhe nonprescrlpLlon producLs LhaL are avallable for LreaLlng arLhrlLls paln are nSAlus 1hese
drugs are ofLen recommended before analgeslcs for people who have osLeoarLhrlLls and evldence of lnflammaLlon
1hey are also recommended for some people wlLh nonlnflammaLory CA who do noL geL adequaLe paln rellef wlLh
slmple analgeslcs nSAlus are dlscussed ln deLall ln a separaLe Loplc revlew (See aLlenL lnformaLlon
nonsLeroldal anLllnflammaLory drugs (nSAlus))

!olnL ln[ecLlons 1wo Lypes of ln[ecLlons are used for people wlLh arLhrlLls paln glucocorLlcold (sLerold) ln[ecLlons
and ln[ecLlons of a llquld known as hyaluronaLe

G|ucocot|co|d (stero|d) |n[ect|ons ClucocorLlcolds can suppress lnflammaLlon and relleve arLhrlLls sympLoms
when ln[ecLed lnLo arLhrlLlc [olnLs

ClucocorLlcold ln[ecLlons may be recommended for people who have osLeoarLhrlLls conflned Lo a few [olnLs and
who sLlll have paln desplLe Lhe use of nSAlus ClucocorLlcold ln[ecLlons may also be recommended for people wlLh
osLeoarLhrlLls who cannoL Lake nSAlus

!olnL ln[ecLlons have few slde effecLs buL some people experlence a brlef flare of arLhrlLls sympLoms afLer an
ln[ecLlon 1here ls also a small rlsk of [olnL lnfecLlon (See aLlenL lnformaLlon !olnL lnfecLlon)

ClucocorLlcolds may damage cerLaln [olnLs when ln[ecLed frequenLly 1herefore cllnlclans recommend no more
Lhan Lhree Lo four ln[ecLlons per year for welghLbearlng [olnLs such as Lhe knees

nya|uronate |n[ect|ons normal [olnL fluld conLalns a large amounL of hyaluronaLe whlch allows Lhe [olnL fluld Lo
be sllppery SynLheLlc hyaluronaLes may be ln[ecLed lnLo Lhe knee Lo LreaL arLhrlLls AfLer Lhe ln[ecLlon paln rellef
may lasL for several monLhs Pyaluronan (Pyalgan) and hylanCl20 (Synvlsc) are Lwo producLs LhaL can be used
LhaL have slmllar effecLs 1hese agenLs are generally ln[ecLed ln Lhe knee buL Lhelr use ln oLher [olnLs ls belng
sLudled

!olnL lnflammaLlon has occaslonally occurred afLer Lhls Lype of ln[ecLlon As wlLh sLerolds Lhere ls a small rlsk of
lnfecLlon 1hus lf you develop severe [olnL paln afLer an ln[ecLlon call your healLhcare provlder lmmedlaLely

nya|uronate |n[ect|ons are genera||y reserved for peop|e w|th osteoarthr|t|s who cannot take NSAIDs or who do
not get adequate pa|n re||ef w|th them eop|e awa|t|ng [o|nt surgery may benef|t from these |n[ect|ons

Colchlclne 1hls drug ls ofLen recommended for people wlLh lnflammaLory osLeoarLhrlLls LhaL does noL lmprove
wlLh nonpharmacologlc Lheraples and nSAlus A cllnlclan may recommend colchlclne for people who have
frequenL flares of osLeoarLhrlLls LhaL ls reslsLanL Lo oLher LreaLmenLs

Pydroxychloroqulne Pydroxychloroqulne (laquenll) has lmmunemodulaLlng effecLs LhaL reduce Lhe
lnflammaLlon of arLhrlLls ln some people 1hls drug may be recommended for people wlLh severe lnflammaLory CA
and Lhose who have bone damage relaLed Lo osLeoarLhrlLls

!Cln1 l88lCA1lCn

uurlng [olnL lrrlgaLlon Lhe [olnL space ls flushed wlLh fluld Lo remove carLllage debrls lrrlLaLlng crysLals and oLher
subsLances ln some people wlLh CA lrrlgaLlon may reduce [olnL paln sLlffness and Lenderness and allow for
lncreased physlcal acLlvlLy

CS1LCA81P8l1lS Su8CL8?

Surgery ls usually reserved for severe arLhrlLls LhaL slgnlflcanLly llmlLs your acLlvlLles and does noL respond Lo oLher
arLhrlLls LreaLmenLs (See aLlenL lnformaLlon 1oLal knee replacemenL (arLhroplasLy))

Powever surgery ls recommended before arLhrlLls causes compllcaLlons such as muscle loss and [olnL deformlLles
lurLhermore Lhose who undergo surgery should be ln Lhe besL posslble physlcal condlLlon and prepared for
rehablllLaLlon afLer surgery

More deLalled lnformaLlon abouL surgery for arLhrlLls ls avallable separaLely (See Surglcal Lherapy of
osLeoarLhrlLls)

ArLhroscoplc LreaLmenL

Arthroscop|c synovectomy ArLhroscoplc synovecLomy ls Lhe surglcal removal of Lhe synovlum (Lhe [olnL llnlng)
uslng an arLhroscope (a Lhln llghLed Lube) LhaL ls lnserLed lnLo Lhe [olnL lnflammaLlon of Lhe synovlum appears Lo
play a key role ln arLhrlLls ln some people SynovecLomy may be recommended for people who have lnflammaLory
osLeoarLhrlLls LhaL does noL respond Lo oLher measures

ArLhroscopy and [olnL lrrlgaLlon 1he beneflL of arLhroscoplc surgery ln people wlLh arLhrlLls ls conLroverslal ln
one sLudy paLlenLs who had real arLhroscoplc LreaLmenL and [olnL lrrlgaLlon were compared Lo oLhers who had a
sham procedure 3 1hose who had Lhe sham surgery were Laken Lo Lhe operaLlng room where Lhe docLor
slmulaLed arLhroscoplc surgery (buL dld noL perform Lhe acLual procedure) osLprocedure lmprovemenL ln
sympLoms was slmllar ln boLh groups

A selecLed group of paLlenLs wlLh arLhrlLls may beneflL from arLhroscopy Powever people wlLh slgnlflcanL arLhrlLls
are more llkely Lo beneflL from oLher Lypes of surgery

ea||gnment(Csteotomy) Surgery may be used Lo reallgn bones and oLher [olnL sLrucLures LhaL have become
mlsallgned because of longsLandlng arLhrlLls lor Lhe knee reallgnmenL may shlfL welghL bearlng Lo healLhler
carLllage Lo relleve arLhrlLls paln 1hls Lype of allgnmenL may be recommended for younger and more acLlve
paLlenLs lnsLead of [olnL replacemenL surgery

luslon Surgery may be used Lo permanenLly fuse Lwo or more bones LogeLher aL a [olnL 1hls may be
recommended for badly damaged [olnLs for whlch [olnL replacemenL surgery ls noL approprlaLe luslon may be
recommended for [olnLs of Lhe wrlsL and ankle and Lhe small [olnLs of flngers and Loes

!olnL replacemenL Surgery may be used Lo replace a damaged [olnL wlLh an arLlflclal [olnL 1he mosL common
reason for havlng [olnL replacemenL surgery ls when paln ls noL conLrolled by a comblnaLlon of nonpharmacologlc
and drug LreaLmenLs

!olnL replacemenL surgery dramaLlcally relleves paln ln people wlLh severe arLhrlLls of Lhe hlp or knee and Lhls
beneflL appears Lo lasL for aL leasL Lhree years Powever lL may Lake up Lo one year before Lhe beneflLs of [olnL
replacemenL surgery become fully apparenL

lor more lnformaLlon abouL [olnL replacemenL (see aLlenL lnformaLlon 1oLal knee replacemenL (arLhroplasLy)
and aLlenL lnformaLlon 1oLal hlp replacemenL (arLhroplasLy))

CarLllage grafLlng Surgery may be used Lo grafL new carLllage cells lnLo damaged reglons of carLllage AL Lhls
Llme Lhe beneflLs of carLllage grafLlng ln arLhrlLlc [olnLs ls sLlll belng sLudled CarLllage grafLlng ls llkely Lo be mosL
pracLlcal when Lhe carLllage damage ls conflned Lo a very small area LhaL ls surrounded by normal carLllage
CurrenL Lechnlques are noL helpful for people wlLh large areas of Lhln or absenL carLllage



ArLhroscopy
ArLhroscopy ls a surglcal procedure LhaL uses small lnclslons and mlnlaLure lnsLrumenLs A Llny Lelescope called an
arLhroscope ls lnserLed lnLo Lhe [olnL space whlch ls Lhen fllled wlLh flulds so Lhe surgeon can clearly see Lhe
componenLs of Lhe [olnL 1hls enables Lhe surgeon Lo look dlrecLly aL Lhe bone surfaces and deLermlne how
advanced your arLhrlLls ls


CsLeoLomy
An osLeoLomy may be recommended lf damage Lo your knee carLllage ls prlmarlly ln one secLlon (comparLmenL) of
Lhe knee 1he lnslde (medlal) comparLmenL where Lhe lnner knob of Lhe Lhlghbone (femoral condyle) meeLs Lhe
Lop of Lhe shlnbone (Llbla) ls mosL commonly lnvolved

An osLeoLomy can resLore knee funcLlon and dlmlnlsh osLeoarLhrlLls paln lL may even sLlmulaLe Lhe growLh of new
carLllage AlLhough an osLeoLomy can decrease paln and lmprove funcLlon Lhe resulLs ofLen deLerloraLe over Lhe
long Lerm Many people who have an osLeoLomy wlll evenLually need a LoLal knee replacemenL (arLhroplasLy)


ArLhroplasLy
An arLhroplasLy ls a [olnL replacemenL procedure lf your knee paln ls severe and slgnlflcanLly llmlLs your
movemenL your physlclan may recommend LhaL Lhe dlseased bone and Llssue be replaced by an arLlflclal [olnL