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
• Inflammation that erodes and
irritates the joint
What is Arthritis?
• Causes or etiology
–Osteoarthritis
–Inflammatory arthritis
• Crystals = gout or pseudogout
• Rheumatoid, lupus, psoriatic
• Infectious or post-infectious
reactive
–
Arthritis Symptoms
• Pain
• Swelling
• Stiffness
• Loss of function
Arthritis Symptoms
• Crunching
• Grinding
• Giving Way
• Instability
• Weakness
Arthritis Treatment Goals
• Reduce your pain
• Improve your function
Arthritis Treatment Goals
• There is no validated way to
regrow the lost cartilage
Arthritis Treatment Options
• Osteoarthritis = wear and tear
arthritis
Arthritis Treatment Options
• Applicable to
all arthritic
symptomatic
joints
• Treatment
spectrum
– Low risk/reward
– Higher risk/reward
– You choose what
treatment you want
Arthritis Treatment Options
• Live with it – no risk, no reward
Arthritis Treatment Options
• Activity and Lifestyle modification
–if it hurts don’t do it
–Weight loss = aquatic programs
Arthritis Treatment Options
• Physical Therapy –
increased strength and
flexibility can decrease
your symptoms
–Muscles are the shock
absorbers for joints
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
Arthritis Treatment Options
• Cane or Walker – may unload
pressure on hip, knee, or ankle
joints at the cost of your
shoulders
Arthritis Treatment Options
• Oral medications
–Tylenol
–Aspirin
–Ibuprofen = advil
–Naproxen = aleve
Arthritis Treatment Options
• Oral medications
–Celecoxib = celebrex
–Meloxicam = mobic
–Indomethacin
–Arthrotec
–Lodine
–So many more
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
Arthritis Treatment Options
• Topical remedies
–NSAID gel or patch
•Voltaren gel
•flector patch
•ketoprofen cream
–Lidocaine patch
•lidoderm
–OTC
•Capsaicin
•menthol
Arthritis Treatment Options
• Injectable therapy
–Cortisone = steroids
–viscosupplements
Arthritis Treatment Options
• Injectable therapy
–Cortisone = steroids
•Single injection
•Okay for any joint
•Pain relief within several days
•3 months typical relief
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
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
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
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
Arthritis Treatment Options
• Surgical options
–Arthroscopic
–Joint Replacement = arthroplasty
–Osteotomy = realignment
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
Arthritis Treatment Options
• Surgical options
–Arthroscopic
•Lavage = wash out
Arthritis Treatment Options
• Surgical options
–Arthroscopic
•Debridement or abrasion
chondroplasty= clean up and smooth
Arthritis Treatment Options
• Surgical options
–Arthroscopic
•Microfracture = stimulate with an awl
to generate fibrocartilage – not hyaline
or articular cartilage
Arthritis Treatment Options
• Surgical options
–Arthroscopic
•Transplant = auto or allo OATS = rob
peter (or cadaver) to pay paul
Arthritis Treatment Options
• Surgical options
–Arthroscopic
combined open
•Carticel = aci =
autologous
chondrocyte
implantation
•Works well in
sweeden
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
Arthritis Treatment Options
• Surgical options
–Joint Replacement = arthroplasty
•knee
Arthritis Treatment Options
• Surgical options
–Joint Replacement = arthroplasty
•hip
Arthritis Treatment Options
• Surgical options
–Joint Replacement = arthroplasty
•shoulder
Arthritis Treatment Options
• Surgical options
–Joint Replacement = arthroplasty
•Shoulder resurfacing
Arthritis Treatment Options
• Surgical options
–Joint Replacement = arthroplasty
•Biologic shoulder resurfacing
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
Arthritis Treatment Goals
• Reduce your pain
• Improve your function
• There is no validated way to
regrow the lost cartilage
Arthritis Treatment Options
• Activity and Lifestyle modification
• Physical therapy, braces, canes
• Oral medication and supplements
• Topical medications
• Injectable medications
• Surgical options
–Arthroscopic
–Arthroplasty
Thank You
Questions?
www.bjc-houston.com
713-790-1818