MetroCreative

I find myself remarking regularly on the passage of time, with particular reference to its effect on the human body. Naturally, disease and ill-health are usually the objects of discussion. As many will attest, the passing of time leads inexorably to joint pain, more specifically the development of osteoarthritis. Unfortunately, the general attitude toward osteoarthritis is one of defeated resignation, that the pain, disability and deformity, are all to be expected, and also accepted. Too often, the individual affected is resigned, apparently helpless, with nary a thought to their treatment options, and how they might obtain some measure of relief.

Osteoarthritis is the most common type of arthritis found in the U.S. and is also the most common disease of joints in adults throughout the world. It can affect many joint-related structures, including those inside the joint (intra-articular) and those tissues outside. Thus, it can affect bone, cartilage, muscle, nerves, and other structures. Pain, disability, deformity, are common complications of this disease.

Traditionally, the focus of treatment has been on late-stage osteoarthritis via joint replacement or fusion, but these efforts have not yielded effective outcomes. Nor do they modify the course of the disease in any way. Primary healthcare has generally been uninterested in benign joint pains and overwhelmed by more pressing problems. It is far simpler, in the course of another busy day to prescribe an anti-inflammatory, but patients are inappropriately maintained on these potentially harmful, palliative drugs for years. Then, when the pain becomes disabling, they are referred for surgery, with the associated costs, and potential for disability and complications.

Many have opined that our approach to managing joint pain in the elderly patient is inappropriate, inefficient, and wasteful. Just as importantly, we are not modifying the course of the disease; we react to symptoms by reducing them but not the disease. But gradually, ever so slowly, the tide is turning. Many in healthcare recognize the inadequacy of our approach and see the need for more proactive measures. Yes, there is a new paradigm: from palliation to prevention.

Non-pharmacological treatments are becoming recognized as a more effective long-term approach to management, such as providing patient education and self-management strategies, advising weight loss, strengthening and physical therapy programs. Especially effective but not generally used is the evaluation of biomechanical issues, which may be addressed with bracing or foot orthoses. Naturally, for knee problems, poor foot alignment can be expected to place greater physical stress on the joint, so foot bracing is often beneficial.

Current guidelines indeed recommend various orthopedic measures for relief of pain, as well as intra-articular corticosteroids. Incidentally, recent studies reveal there are no significant differences between synthetic joint fluid injection and corticosteroids in terms of pain relief or improvement in function for osteoarthritis.

Exercise provides us with an efficacious, safe, low tech, low cost treatment, available to the large population of patients who need it, when they need it. Muscle is the tissue we can most easily manipulate, with an exercise regimen improving muscle function, joint pain, stability and function. Yet less than half of patients with joint disease receive exercise advice, with a tiny minority benefitting from effective rehabilitation regimens. What’s more, virtually no resources are allocated to helping and encouraging patients to exercise.

No longer “on the horizon” is regenerative medicine, an exciting new approach to the treatment of musculoskeletal pain. This term encompasses various techniques all directed at stimulating healing, primarily through the action of stem cells. Pain relief is an obvious benefit of stimulating tissue repair. From the application of tiny bursts of powerful sound waves (shock wave therapy) to the injection of specific blood cells from your own blood (PRP), many new methods have been discovered and are being utilized currently, often to great benefit. Although much research is needed and these techniques are not yet as precisely defined as many commercial drugs, they have the potential to alter the practice of medicine. And provide a better option for those suffering from the consequences of the common condition that is osteoarthritis.

It would appear that the vast majority of the public, patients included, even those in healthcare, regard osteoarthritis as an inevitable consequence of life. And that, by its very nature, it’s going to result in a relentless deterioration of function. It seems to be taken for granted that this is a disease that is not only incurable but also virtually untreatable. Yet studies reveal that exercise, along with appropriate bracing and support, can allow for continued function and reduced pain. Our attitude toward this all too common condition is one that must be overcome, with education being a cornerstone of this effort. There are better options out there, but you must seek them out.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.