Ask a doc: How is osteoarthritis treated?

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Osteoarthritis cannot be reversed but there are treatments that can help alleviate symptoms like pain, swelling, and discomfort. In mild to moderate cases, patients are usually put on medication, are advised to exercise, or they can try PRP or platelet-rich plasma therapy. In severe cases, the damaged joint can be surgically replaced, says Dr. Abhishek Kumar Mishra, orthopaedic and joint replacement surgeon, Apollo Spectra Hospitals. He spoke to Femoai about the treatment of osteoarthritis. Edited excerpts:

Stages and treatment of osteoarthritis

The treatment of osteoarthritis depends on the stage of the disease. The symptoms of the patients and a simple X-ray is sufficient to identify the stage of osteoarthritis and to decide the course of treatment. Osteoarthritis can be mild, moderate, or severe. Mild would mean occasional pain and swelling, not too much restriction of range of motion, and little interference in daily activities. At this stage, keeping the joints healthy with regular exercise, taking analgesics as and when needed, hot fermentation, trying to lose weight if someone is overweight, these help in easing the pain and ensure that the disease doesn’t advance too rapidly. 

If we see grade two or grade three osteoarthritis on the X-ray, but the patient is not very symptomatic, there is little pain and no deformity, we restrict ourselves to conservative treatment — exercises and analgesics on an SOS basis, hot fermentation, and losing weight in case of overweight patients. It might sound counterintuitive in the case of osteoarthritis but exercise helps build muscle and strengthens the joints, it also helps in losing weight, which can help in easing the symptoms. You can consult your doctor or a physiotherapist and create an exercise plan.

Apart from that, we can think of injections in the joint. There are certain types of injections that are helpful in acute episodes of pain. They can also help in restoring joint mobility to a certain extent. There are a few common injections that are available for mild to moderate osteoarthritis. One is hyaluronic acid injection, also called viscosupplementation. Hyaluronic acid is a drug that can be injected directly into the knee joint. It comes in prefilled syringes, in a prepared form, and for patients with mild or moderate osteoarthritis, it offers pain relief for anywhere between six months to three years. The duration varies depending on individual cases. The patient can use this period of pain relief to exercise and build muscle to make the area around the joint less painful.

There are also some newer modalities like PRP, which have been available in the West for a long time, but in India we started administering them about 8-10 years ago.

In my experience, PRP injections are very helpful if the patient has mild to moderate osteoarthritis, and if the patient is relatively younger. PRP injections are cell based injections wherein ingredients from the patient’s own blood are used to treat damaged tissues. The process involves withdrawing some blood from the patient, centrifuging it, isolating a concentration of platelets and injecting it back into the knee joint. Platelet rich plasma contains certain growth factors that are supposed to help in rebuilding the cartilage to a certain extent.

In cases of mild to moderate osteoarthritis, which is symptomatic, patients can consider PRP injections in addition to conservative treatment, in consultation with their doctor.

Like I mentioned, it is not just the radiological finding, the x-ray or the classification which matters in the treatment of osteoarthritis, we have to take the symptoms into account as well. If a patient has a bad x-ray and is in a lot of pain that hinders their daily life, they should consider surgery rather than going for conservative management. Whereas patients whose x-ray may be bad, but they are not in pain, they can opt for conservative treatment or injections.

It is not just the radiological finding, the x-ray or the classification which matters in the treatment of osteoarthritis, we have to take the symptoms into account as well. If a patient has a bad x-ray and is also in a lot of pain that hinders their daily life, they should consider surgery rather than going for conservative management. Whereas patients whose x-ray may be bad, but they are not in pain, they can opt for conservative treatment or injections.

In cases of severe osteoarthritis, joint replacement is an option. Joint replacement is a very successful surgery now and  we use new techniques that make the joint last for a long time.

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