Current Treatment Options for Osteoarthritis of the Knee
For patients who have been diagnosed with osteoarthritis (OA), their physician will determine the best way to treat their condition based on their osteoarthritis severity, their pain, and their lifestyle limitations due to OA.
KELLGREN AND LAWRENCE CLASSIFICATION SYSTEM OF OSTEOARTHRITIS SEVERITY
|Grade 0||Normal joint health with no signs of osteoarthritis.||No symptoms.|
|Grade 1||Early signs of osteoarthritis. Potential minor bone spur growth.||Occasional joint pain or stiffness resulting from minor wear and tear.|
|Grade 2||Classified as mild osteoarthritis. Early erosion of surface cartilage and potential bone spur growth. Cartilage will likely still look healthy and a sufficient amount of synovial fluid is still present.||Localized pain and stiffness.|
|Grade 3||Classified as moderate osteoarthritis. Definite joint space narrowing and cartilage damage. Decrease in the amount of synovial fluid surrounding the joint.||Constant joint pain. Can also experience stiffness or joint swelling when walking, running, or performing normal daily activities.|
|Grade 4||Classified as severe osteoarthritis. Extreme joint space narrowing; bone on bone contact. Little or no cartilage remaining and a dramatic reduction in the amount of synovial fluid surrounding the joint.||Tremendous, often unbearable pain when walking or moving the joint.|
CURRENT OSTEOARTHRITIS TREATMENTS
While there is no cure for OA, there are a number of treatment options that can be explored depending on osteoarthritis severity.
- Lifestyle: weight loss, exercise, protecting your knees from excess stress, physical therapy
- Analgesics: simple pain relievers, such as acetaminophen
- NSAIDS (non-steroidal anti-inflammatory drugs), such as ibuprofen or aspirin
- Steroids, also called corticosteroids
- Viscosupplements: hyaluronic acid (HA), also called sodium hyaluronate or hyaluronan
- Opioids: powerful pain relievers, such as morphine
- Surgery, such as total knee replacement
When conservative approaches to treating knee pain due to osteoarthritis, such as physical therapy, weight loss, exercise, or pain relievers are no longer effective, alternative treatment options may be beneficial, such as steroids or viscosupplements.
Corticosteroid injections have been used for over 45 years for their potent anti-inflammatory effects to reduce pain quickly and allow earlier motion. While steroids provide rapid pain relief, the effects are typically short lived.1,2,3 Corticosteroids have not been shown to slow the progression of joint damage,4 and may cause additional joint damage or even severe joint destruction when intraarticular steroid injections are given repeatedly over a long period of time.5
HA viscosupplements have been used for more than 25 years to reduce pain associated with osteoarthritis, improve the elasticity and function of the synovial fluid and protect the surface of articular cartilage.6,7,8,9 While injections of HA alone can deliver long lasting pain relief, the patient does not typically experience the peak effects until 8 weeks after the final injection.1,2,3,10
Only CINGAL® works by combining a fast acting steroid with a long lasting viscosupplement to deliver rapid pain relief proven to last through six months.*
*In patients with early to moderate osteoarthritis. Patient experience may vary.
1. Bellamy N, Campbell J, Robinson V, et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005328.
2. Ozturk C, Atamaz F, Hepguler S, et al. The safety and efficacy of Intra-articular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study. Rheumatol Int. 2006 Feb;26(4):314-9.
3. de Campos GC, Rezende MU, Pailo AF, et al. Adding triamcinolone improves viscosupplementation: a randomized clinical trial. Clin Orthop Relat Res. 2013 Feb;471(2):613-20.
4. Otto M., et. al. ACR: No long-term benefit for knee OA steroid injections. Rheumatology News Digital Network. Nov. 7,2015.
5. Triamcinolone hexacetonide 20 mg/ml suspension for injection. Intrapharm Laboratories Limited. May 2016. Web: https://www.medicines.org.uk/emc/medicine/28913
6. Fukuda K, Dan H, Takayama M, Kumano F, Saitoh M, Tanaka S. Hyaluronic acid increases proteoglycan synthesis in bovine articular cartilage in the presence of interleukin-1. J Pharmacol Exp Ther 1996; 277: 1672-1675.
7. Asari A, Mizuno S, Tanaka I, Sunose A, Kuriyama S, Miyazaki K, Namiki O. Suppression of hyaluronan and prostaglandin E2 production in traumatic arthritic synovial cells by NaHA. Connective Tissue 1997; 29: 1-5.
8. Takahashi K, Goomer RS, Harwood F, Kubo T, Hirasawa Y, Amiel D. The effects of hyaluronan on matrix metalloproteinase-3 (MMP-3), interleukin-1beta (IL-1beta), and tissue inhibitor of metalloproteinase-1 (TIMP-1) gene expression during the development of osteoarthritis. Osteoarthritis Cartilage 1999; 7: 182-190.
9. Masuko K., M. Murata, K. Yudoh, T. Kato, H. Nakamura. Anti-inflammatory effects of hyaluronan in arthritis therapy: Not just for viscosity. Int J Gen Med. 2009; 2: 77–81.
10. Bannuru R, Natov N, Dasi U, et al. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis. Osteoarthritis and Cartilage 19 (2011) 611-619.