As we come to know more about pathophysiological processes involved inosteoarthritis and measures to check them, it is being increasingly recognized that nonpharmacologic management is as important and often more important than drug treatment.
It is a consensus now that drugs should serve an adjunctive role in the management of this disease.
Nonpharmacologic Measures
Non pharmacological therapy works on following principles
- Joint protection
- Thermal Therapy
- Exercises to strengthen periarticular muscles
- Weight reduction in case of obesity
- Avoidance of excessive loading of the joint by use of shoes with well cushioned soles, a cane or walker
- Orthotics for the patient with varus or valgus knee deformity.
A combination of measures is used for different individuals depending on the patient profile.
If the above measures are ineffective, irrigation of the painful joint warrants consideration.
First line of drug treatment is use of acetaminophen, and because it is cheaper and as effective as NSAIDs as an adjunct to the nonpharmacologic measures mentioned above.
If this does not control joint symptoms in a reasonable period of time, a low dose or an NSAID (e.g., ibuprofen, 1200 mg/d; naproxen, 500 mg/d) may be substituted for, or added to, the acetaminophen.
Tramadol, a weak opioid for which the risk of tolerance and addiction appear to be minimal, may be prescribed if above drug does not bring the relief.
In case of non satisfactory results, an anti-inflammatory dose of an NSAID should be used starting with the minimum admissible dose.
NSAIDs are bettere prescribed on an “as needed” basis, rather than in a fixed daily dose. The pain control has been shown to be comparable and the risk of toxicity is lessened.
The patient needs to assessed regularly for possible reduction of the dosage as the therapy continues.
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