IV. Non-Operative Treatment
1. Activity Modification
2. Weight Loss
3. Supportive Device
4. Exercise
5. Heat
6. Glucosamine
7. Tylenol
8. Anti-inflammatory medication, nonsteroidal (NSAIDS)
9. Steroids and Anti-Rheumatoid medications
Most commonly, arthritis is a “wear and tear” process; once
a joint shows signs of significant degeneration, the more stress it is
subjected to, the more it degenerates. Let me use the analogy of a tire
on a car. If the tread is thin and worn, it will not last very long driving
the car back and forth daily to Atlanta. On the other hand, putting the
car up on blocks preserves the tires, but makes the car useless to you.
As you can see, the appropriate amount of activity modification is a very individual decision based on common sense. As a general guideline,
low stress activities that are usually tolerated well are short distance
walking, exercise bicycle, swimming and water aerobics. High stress activities
(these are not advised) would include jumping, jogging, long distance
walking (> 1 mile) or heavy lifting.
Weight loss will also decrease the stress on a joint.
Because of the muscles acting across the hip joint, normal walking causes
a force across the hip approximately three to five times the body weight.
Therefore, if you are 20 pounds overweight, the force across the hip is
increased by 100 pounds. Even small amounts of weight loss will decrease
the force about the hip, slow down the destruction of the hip joint and
decrease pain. Another way to decrease the force is to use a cane or crutch
in the opposite hand. This decreases the required muscle function about
the hip during walking and reduces the force on the hip by several hundred
pounds.
Exercise is useful mainly to maintain muscle tone and
range of motion. Isometric exercises and gentle range of motion exercises
should be sufficient. Because arthritis is often a problem of “wear
and tear”, vigorous exercises and the use of weights only results
in further deterioration of the joint.
Heat is also helpful to decrease stiffness and relieve
pain. Superficial heat, such as provided by liniments and ointments, etc.,
do not deliver heat deep enough to be beneficial. The best is a hot water
bottle or hot packs because the temperature can be controlled and they
deliver a significant amount of heat deep into the joint. Use of a heated
whirlpool or spa may also be helpful. Use of a heating pad can be helpful,
but care must be taken to avoid burning the skin.
Braces are not effective in the treatment of hip arthritis.
Glucosamine, sometimes in combination with Chondroitin,
is an over the counter remedy that is proven to be effective for relieving
pain. However, it is often advertised as a treatment to rebuild lost cartilage—there
is no scientific evidence for this claim. It does take 2-3 months of regular
use of this material before it “gets into your system” and
relieves arthritis pain. If you notice no improvement in your symptoms
after 2-3 months, it is probably not worthwhile to continue using this
supplement. The usual recommended dosage is 1500 milligrams per day.
Tylenol is a very effective and safe pain reliever for
the treatment of arthritis. It may be taken in conjunction with anti-inflammatory
medications for added benefit. If taken on a regular and prolonged basis,
regular check ups and lab tests by your internist are recommended.
The use of non-steroidal anti-inflammatory medications (NSAIDS) is also an important treatment. Aspirin is the most commonly
used anti-inflammatory medication, but many people cannot take it because
of either allergy or gastrointestinal difficulties. There are many aspirin
substitutes that are currently on the market but are significantly more
expensive than aspirin. None of them have been shown to work any better
than aspirin but they do have less side effects and more convenient dosage
frequencies.
There are probably 25-30 of these types of medication on the market today.
Each company claims superior effectiveness of their own brand. Sometimes
one brand, as opposed to another, may seem to work better for one individual.
However, generally speaking, they are all equally effective. The newer
brands are usually advertised more vigorously and carry a higher price
tag. The earlier brands (Ibuprofen, Naproxen) are no longer under patent
and can be purchased much more inexpensively and often at lower doses
as an over-the-counter formulation.
Special mention should be made of a new subclass of these medicines called
“COX 2 inhibitors” (Celebrex, Vioxx). These have a more specific
action on the joint and less side effects on the stomach and platelets.
Usually, they can even be taken by people with ulcers and by those who
are on blood thinners, such as Coumadin. Their effectiveness in treating
the arthritis symptoms, however, is no different than the other NSAIDS.
More powerful medicine such as steroids, gold (oral or injection) or methotrexate
are often used by rheumatology specialists to treat inflammatory arthritis
such as rheumatoid arthritis. Chiropractic manipulation may be helpful
in alleviating back symptoms that are often confused as “hip pain”,
but there is no role for this in the treatment of hip arthritis. There
are many unproven alternative treatments such as magnets, wraps, devices
and herbs that may act on the basis of a placebo effect.
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