Part III Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota
Dec 27, 2015
Medical Therapy
• Supplements
• Over-the-counter medicines
• Prescription medicines
• Injection therapy
Supplements
• Little scientific evidence for/against products– Not subject to FDA regulations
– Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms
– No evidence for other compounds
OTC Medicines
• Tylenol
• NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve)– Equally effective in all major
studies– Quite safe when taken with
supervision• Stomach ulcers
• Kidney trouble
Prescription Medicines
• Prescription NSAIDs– Celebrex, Mobic, etc– No better than ibuprofen
or naprosyn in comparable doses
• Benefits for select patients• Primary benefit is
convenience
– Cardiovascular risks unknown
Prescription Medicines - Opiates
• Synthetic derivatives of morphine– Effective– But… tolerance building and habit
forming– Frequent depression and side
effects
– Used very selectively and carefully under specialty supervision
Physical Therapy
• Important aspect of joint care in SS
• Particularly important before and after any surgery
Injection Therapy
• Injection of cortisone or hyaluronic acid derivatives
• Effective in ~2/3rds patients
• Effect often fades
• Safe for up to 3-4 times/year
Fusion
• Traditional treatment for arthritis in the young– “No motion, no pain”
• Not for patients with multiple joint involvement– Spine, ankle, wrist
possible exceptions
Arthroscopy
• Low morbidity outpatient procedure• Doesn’t “burn” bridges
– Effective against well defined targets• Focally torn cartilage
– Not effective for generalized joint pain or arthritis
Realignment Procedures - Knee
• Surgically change alignment to “offload” worn area
• Delay need for joint replacement