Doctor massaging a patient's knee

Osteoarthritis Pain Treatment Options

Hyaluronic acid injections (viscosupplementation) and corticosteroids for pain caused by Osteoarthritis of the knee

If you’re living with knee osteoarthritis (OA), you know firsthand the toll that joint pain can take on your life – even during daily activities.

While there is no cure for OA, you have more treatment options than you may think to relieve knee pain. Over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can relieve joint pain. Prescription pain medications and joint replacement surgery may also be options, but these are not the only ways to find relief for OA knee pain.

Joint injections may be a nonsurgical option to relieve pain in the knee joint, and may also be suitable for individuals whose surgery is cancelled or delayed.

A key component of nonoperative strategies are intra-articular injections.

-Arthroscopy Association of Canada 2019

While there are a few different kinds of injections for relieving OA knee pain available in Canada, we’ll specifically be discussing two of the options which have been reviewed by the Canadian Orthopaedic Association and the Arthroscopy Association of Canada – corticosteroid injections and intra-articular hyaluronic acid (IAHA).

Depending on the severity of your pain and the stage of your OA, you and your doctor can discuss what might work for you to provide joint pain relief.

Corticosteroid and intra-articular hyaluronic acid injections for OA knee pain

CORTICOSTEROIDS
Synthetic corticosteroids have been used for over 50 years. They are used to reduce joint pain and inflammation. There are a number of options available. Ask your doctor which one could be suitable for you.

Safety info:
Be sure to discuss and weigh the potential benefits and risks of these knee injections with your doctor. You can also review the product information for a complete list of side effects. Potential side effects may include allergic reactions (such as anaphylaxis), cardiovascular issues (such as heart attack, high/low blood pressure, blood clots), skin issues (such as swelling, rash, redness, itching, gastrointestinal issues (such as stomach bleeding, nausea, vomiting, abdominal pain), musculoskeletal issues (such as a loss of muscle mass or joint pain), neurologic effects (such as seizures, headache, a sensation of skin tingling or burning), etc. Other side effects may occur.

HYALURONIC ACID (or HA)
HA is naturally present in joint fluid (called synovial fluid). The first injection of hyaluronic acid was approved in Canada for the treatment of mild to moderate OA of the knee in 1992. It is intended only for use by a physician to treat pain associated with osteoarthritis. Viscosupplementation with HA is a treatment to decrease pain and discomfort, allowing more extensive movement or functionality of the joint.

There are a few formulations in Canada which may vary in thickness or molecular weight, some reaching up to 6,000 kDa. [Ref 1 Guidelines p. 2] Ask your doctor which one could be suitable for you.

Safety info:
Be sure to discuss the benefits compared to the potential risks or side effects with your doctor. You can also review the product information for a complete list of possible side effects. Pain or swelling in the injected joint and allergic reactions (like anaphylactic reaction) may occur after injections. Rarely, rash, hives, itching, fever, nausea, headache, dizziness, chills, muscle cramps, a burning or prickling sensation, swelling of the lower legs or hands, malaise, respiratory difficulties, flushing and facial swelling have been reported.

Take action: Manage your osteoarthritis pain

There are many potential causes of joint pain, especially in weight-bearing joints like the hips, knees & ankles. But if your osteoarthritis story includes knee problems, ask your healthcare provider what treatment options or pain medications may ease pain and could be right for you. Talk to your doctor about exploring a multimodal treatment approach, where you can combine various treatment options for osteoarthritis such as diet, exercise, medication, viscosupplementation, bracing, etc.

Asking for an x-ray of the affected joint (while standing) at a physical examination is a good place to start if you're experiencing symptoms of osteoarthritis or arthritis pain. Make sure to take one while standing for knee OA, so your doctor can see the space between the bones and examine the cartilage. Certain risk factors like carrying excess body weight, being female, obesity, and having a damaged joint due to injury are commonly linked to this form of arthritis.

You might consider consulting a physical therapist, physiotherapist, or occupational therapist to discuss your mobility, appropriate low impact and strengthening exercises, and physical therapy. This may be especially relevant if you've had a knee injury – one of the common causes of knee pain. A physiotherapist can help you with personalized exercises. A Certified Orthotist or brace fitter can provide you with a brace, orthosis or orthotic.

In general, low-impact exercises like tai chi are well-suited for this type of arthritis to avoid joint injury. Overall, physical activity or exercise programs are also very complementary to other treatments, as is maintaining a healthy weight (or weight loss if necessary). Consult a fitness and nutrition specialist to help find the right exercise and diet plan for you. Don't underestimate the impact that lifestyle changes can have!

You can also visit an orthopedic clinic to assess joint damage (or for general medical advice). Or your family physician may be able to refer you to a medical professional who specializes in the care of joints, ligaments and bones, or a musculoskeletal specialist. This may include sports medicine physicians, orthopedic surgeons, rheumatologists, and physiatrists.

Be sure to discuss any benefits and potential side effects of treatment you're considering, and ask about options that may be tried before knee replacement surgery or joint replacement surgery (also known as arthroplasty). It's your own wellness and quality of life, so don't hesitate to speak up about painful joints, OA pain, arthritis symptoms in general, or your treatment plan!

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