Osteoarthritis Treatment [Neurosurgery Wiki]

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====== Osteoarthritis Treatment ======

**[[Lifestyle]] Modifications**: [[Weight]] management and low-impact [[exercise]] can reduce joint [[stress]] and improve mobility.

**[[Physical Therapy]]**: Exercises to strengthen muscles around the joint and improve range of motion.

===== Medications =====

**Analgesics** (e.g., acetaminophen) and **NSAIDs** (e.g., ibuprofen) for pain relief.

**Topical Agents**: Creams containing [[capsaicin]] or NSAIDs applied to the skin.

**Injections**:

**Corticosteroids**: Injections to reduce inflammation and pain.

**Hyaluronic Acid**: To improve joint lubrication (though the effectiveness is debated).

===== Surgery =====
[[Spinal osteoarthritis surgical treatment]].

===== Prevention and Management =====


- **Maintain Healthy Weight**: Reducing body weight decreases joint load, particularly in weight-bearing joints.
  
- **Regular Exercise**: Activities like swimming and cycling can strengthen joint-supporting muscles without adding joint stress.
   
- **Joint Protection**: Using supportive braces or altering activities to prevent joint strain.

The development of valid and feasible [[quality]] indicators (QIs) is needed to track quality initiatives for [[osteoarthritis]] [[pain management]] in primary care settings.

A literature search identified published guidelines that were reviewed for QI extraction. A panel of 14 [[expert]]s was assembled, including [[primary care]] physicians, rheumatologists, orthopedic surgeons, pain specialists, and outcomes research pharmacists. A [[screening]] survey excluded QIs that cannot be reliably extracted from the [[electronic health record]] or that are irrelevant for osteoarthritis in primary care settings. A [[validity]] screening survey used a 9-point Likert scale to rate the validity of each QI based on predefined criteria. During the expert panel, [[discussion]]s, [[stakeholder]]s revised QI wording, added new QIs, and voted to include or exclude each QI. A priority survey used a 9-point Likert scale to prioritize the included QIs.

A literature search identified 520 references published from January 2015 to March 2021 and 4 additional guidelines from professional/governmental websites. The study included 41 guidelines. The extraction of 741 recommendations yielded 115 candidate QIs. Feasibility screening excluded 28 QIs. Validity screening and expert panel discussion excluded 73 QIs and added 1 QI. The final set of 15 prioritized QIs focused on pain management safety, education, weight management, psychological well-being, optimizing first-line medications, referral, and imaging.

This multi-disciplinary expert panel established consensus on QIs for osteoarthritis pain management in primary care settings by combining scientific evidence with expert opinion. The resulting list of 15 prioritized, valid, and feasible QIs can be used to track quality initiatives for osteoarthritis pain management
((Rizk E, Tajchman S, Fink E, Aryal DK, Iso T, Flores E, Brown AE, Chokshi SP, Desai SN, Dewan AK, Kazzaz SA, Guevara M, Nagaraj S, Robben CP, Vittone V, Swan JT. Quality indicators for osteoarthritis pain management in the primary care setting. BMC Musculoskelet Disord. 2023 Jun 30;24(1):538. doi: 10.1186/s12891-023-06637-x. PMID: 37391737.)).

===== Ketogenic Diet for Osteoarthritis Treatment =====


==== Potential Benefits ====

Anti-Inflammatory Effects: Studies suggest that KD may reduce inflammation by inhibiting the NLRP3 inflammasome, a component involved in inflammatory responses. In a rat model of OA, KD significantly decreased joint inflammation and cartilage degradation. 

Weight Management: Obesity is a known risk factor for OA. KD has been effective in promoting weight loss, which can alleviate stress on weight-bearing joints and potentially reduce OA symptoms. 
MDPI

Pain Reduction: By decreasing systemic inflammation and body weight, KD may contribute to reduced joint pain and improved function in individuals with OA.

Considerations and Risks

Nutrient Deficiency: Strict adherence to KD may lead to deficiencies in essential nutrients, including vitamins and minerals vital for bone health. 

Hepatic Steatosis: Long-term KD has been associated with the development of fatty liver in animal studies. Modifications, such as intermittent KD or supplementation with vitamin D, have been proposed to mitigate this risk.

Conclusion

While preliminary studies indicate that KD may offer benefits in managing OA through anti-inflammatory effects and weight reduction, further research is necessary to fully understand its efficacy and safety in humans. Individuals considering KD for OA treatment should consult healthcare professionals to ensure a balanced approach that addresses potential risks and nutritional needs.
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The [[ketogenic diet]] (KD) has demonstrated efficacy in ameliorating [[inflammation]] in [[rat]]s with [[osteoarthritis]] (OA). However, the long-term [[safety]] of the KD and the underlying mechanism by which it delays OA remain unclear. 
Cai et al. found that while long-term KD could ameliorate OA, it induced severe hepatic [[steatosis]] in [[mice]]. Consequently, they developed two versions of ketogenic-based diets: KD supplemented with [[vitamin D]] and intermittent KD. Both KD supplemented with vitamin D and intermittent KD effectively alleviated OA by significantly reducing the levels of inflammatory [[cytokine]]s, cartilage loss, sensory nerve sprouting, and knee [[hyperalgesia]] without inducing hepatic steatosis. Furthermore, β-hydroxybutyrate (β-HB), a convenient energy carrier produced by [[adipocyte]]s, could ameliorate OA without causing liver lesions. Mechanistically, β-HB enhanced [[chondrocyte]] [[autophagy]] and reduced [[apoptosis]] through the activation of the [[Erb-B2]] receptor tyrosine kinase 3 ([[ERBB3]]) signaling pathway; a pathway which was down-regulated in the articular chondrocytes from both OA patients and mice. Collectively, the findings highlighted the potential therapeutic value of β-HB and KD supplemented with [[vitamin D]] and intermittent KD approaches for managing OA
((Cai Z, Zhang Z, Leng J, Xie M, Zhang K, Zhang J, Zhang H, Hu H, Deng Y, Bai X, Song Q, Lai P. β-hydroxybutyrate ameliorates [[osteoarthritis]] through activation of the ERBB3 signaling pathway in mice. J Bone Miner Res. 2024 Nov 5:zjae176. doi: 10.1093/jbmr/zjae176. Epub ahead of print. PMID: 39498503.)).