INVESTIGATIONS FOR OSTEOARTHRITIS
1. Blood Test: No blood tests are helpful in diagnosing OA. However investigations to rule out other causes of arthritis like gout, rheumatoid arthritis, lupus and also joint infection might be carried out. Joint fluid might need be aspirated for joint fluid examination for the same purpose.
2. X-RAY & MRI: An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs. To detect very early OA changes MRI might be needed.
TREATMENT FOR OSTEOARTHRITIS
1. Negative aspect: Osteoarthritis is a degenerative disorder. It is thought that there is no permanent cure. Once it is detected it is expected to progress further. It will most likely get worse over time. However, your OA symptoms can be controlled. Here, I would want to warn the patients that they should not get trapped by false promises. Whoever claims that they or their medicine can cure the disease is making false promises. All medicines available today are palliative. This scenario is more true for advanced disease where cartilage has almost completely worn out, making the ends of the bones rub against each other, thus causing much pain, in which case you will need surgery. Other treatments can improve your pain and make your life much better. Although these treatments cannot make the arthritis go away, they can often delay surgery.
2. Positive aspect: Let me be positive now, a lot can be done to delay the further degeneration of the cartilage, if you report to a joint pain doctor (Rheumatologist) early in the course of illness, when your knees or other joints have just started getting heavy and stiff. We may identify the risk factors which are causing your arthritis. We can modify most of the modifiable risk factors and prolong the life of the cartilage and can save it from further degeneration.
Nowadays, delaying the cartilage damage and even possibility of regeneration is being actively pursued. This involves repairing the internal joint tissues and even the cartilage to some extent. There have been some studies and case reports of some celebrities including Tiger wood whose injured tissues are claimed to have recovered after injection of his own cells in popularly known as PRP (Platelet rich plasma) therapy. It is the beginning of an era of regeneration medicine. This involves injecting your own cells including platelets along with small amounts of plasma and even stem cells have been tried with allegedly good results in many instances. At present, these therapies are called experimental therapies (science has evolved through experiments) and are done with informed consent of the patient. These therapies may work in some individuals, in some may not. But therapies have been proved to be safe without any serious side effects. In US and Europe, people are trying these with good outcomes as far as available literature goes. But jury is of the opinion that it can be tried before surgery when other nonsurgical therapies have failed to relieve the pain and in all of those cases where no contra indication exists and OA has not progressed far too advanced to the point of no return..
MEDICINES FOR OSTEOARTHRITIS
Most doctors recommend acetaminophen (Paracetamol, crocin) first, because it has fewer side effects than other drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin ibuprofen and naproxen which can be used if pain is not relieved with acetaminophen. These medicines are used with caution especially in those with upper abdominal pain, dyspepsia, peptic ulcers, or having bleeding disorders, or kidney diseases.
Other medications or supplements that you may be given by Rheumatologist include:
- Intra articular steroid injections to reduce pain and swelling.
- Nutracuticals such as glucosamine and chondroitin sulfate may reduce pain in some patients but do not expect cure or regeneration of structures of the joints as is being claimed, so do not get misguided.
- Capsaicin skin cream may be helpful.
- Artificial joint fluid (Synvisc, ferovisc) can be injected into the knee to relieve pain for 3 – 6 months, it reduces the friction between the joint ends, it costs the patient between 20000/- to 34000/-
- In west, PRP therapy is progressing at very faster pace, and has been proved safe and effective in small case series and case reports, however result of large studies are awaited. Cost is prohibitive at present ranging between 1000- 2000 dollars. Amounting to 50000/ to 100000//- per injection. We are developing the method with similar efficacy at lower cost, so that large number of people can benefit.
- Even Stem cell are being tried under informed consents to regenerate the joint tissues.