November 2001 • POST-ASSEMBLY EDITION
Osteoarthritis landscape changes as well
Treatments for osteoarthritis have changed dramatically with the introduction of topical therapies and intra-articular injections that can manage a patient's pain quickly, said FP Cheryl Lambing, M.D., of Ventura, Calif. Lambing presented a Scientific Assembly mini-course on the topic (see above story).
For decades, she said, the American College of Rheumatology, Arthritis and Rheumatism recommended that osteoarthritis patients first concentrate on weight loss, physical and occupational therapy, aerobic exercise and walking aids. Pharmacologic treatment began with acetaminophen, followed by low-dose ibuprofen if needed. If the patient's response was still inadequate, alternative or higher-dose nonsteroidal anti-inflammatory drugs were tried.
Now, topical solutions, some including NSAIDs, offer quick relief. And injections deliver corticosteroids directly into the affected joint, Lambing said. However, corticosteroids may not be effective for at least four weeks, and "that's where viscosupplementation comes in," she said.
Viscosupplementation, which uses newer hyaluronic acid preparations, has been around since 1998 but still is not performed often by family physicians. One reason, said Lambing, is that currently it is approved only for one series of injections, in one joint, in one disease process. It can also be difficult to find training in the procedure.
Two viscosupplementation agents, hylan G-F 20 and sodium hyaluronate, are currently available. Treatment consists of injection of one of these drugs into the affected joint to replace the pathologic fluid. Often, patients report a chemical irritation in the joint, but it dissipates quickly, Lambing said.
All in all, said Lambing,"You should always consider it. The patient can feel relief two to three weeks after the injections, compared with four or more weeks with corticosteroids."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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