1. OSTEOARTHRITIS conservative therapy: a practical approach Alexander R. Shikhman MD, PhD, FACR ifsmed.com

2. PRESENTATION MATERIALS Slides available on slideshare.com/ifsmed Video available on youtube.com/ifsmed 3. OSTEOARTHRITIS A degenerative joint disease characterized by: cartilage loss changes in the subchondral bone (bone underlying the cartilage) adaptive changes in tendons and ligaments mechanical misalignment eventual loss of the joint function 4. OSTEOARTHRITIS SYMPTOMS AND SIGNS pain after physical activity joint swelling joint stiffness loss of joint flexibility/function changes in the joint appearance/joint deformities 5. OSTEOARTHRITIS PRINCIPLES OF THERAPY Control of pain and inflammation NSAIDs Acetaminophen Opioid analgesics Viscosupplementation therapy Food supplements Physical therapy (modalities) Bionicare device Prevention of cartilage degeneration Viscosupplementation therapy Food supplements Restoring joint function Food supplements Viscosupplementation therapy Physical therapy Orthotics 6. VISCOSUPPLEMENTATION THERAPY INDICATIONS Joint pain Osteoarthritis CONTRAINDICATIONS Ongoing joint inflammation (active synovitis) Crystal-induced arthropathy (gout/pseudogout) Infection 7. VISCOSUPPLEMENTATION THERAPY PREDICTORS OF GOOD OUTCOME Mild to moderate joint deformities Absence of large synovial effusions Well-preserved periarticular muscle mass Minimal joint instability 8. VISCOSUPPLEMENTATION THERAPY High Success Rate Knees 1st CMCs TMJs Moderate Success Rate Hips Ankles Low Success Rate Shoulders 9. VISCOSUPPLEMENTATION THERAPY OUTCOME OPTIMIZATION Pre-viscosupplementation intraarticular steroid injection Injection in a dry joint Selection of the right viscosupplementation agent Ultrasound guidance of joint injections Post-injection joint immobilization Physical therapy Food supplements Post-viscosupplementation platelet-rich plasma (PRP) therapy 10. ULTRASOUND GUIDANCE OF JOINT INJECTIONS Better assessment of joint anatomy Avoidance of unexpected findings Crystals (calcium pyrophosphate, urate,etc.) Active synovitis or active tendinitis Hidden effusions Guaranteed drug delivery to the joint space Biofeedback effect 11. MUSCULOSKELETAL ULTRASOUND UNEXPECTED SOURCE OF KNEE PAIN 12. ULTRASOUND GUIDED KNEE ARTHROCENTHESIS 13. ULTRASOUND GUIDED HIP INJECTION WITH EUFLEXXA 14. FOOD SUPPLEMENTS FOR OA CARTILAGE MATRIX OPTIMIZERS VISCOELASTICITY Chondroitin Sulfate Celadrin MSM Oral Hyaluronic Acid N-Acetylglucosamine Oral Hyaluronic Acid Oral Collagen Type 2 INHIBITORS OF INFLAMMATION INHIBITORS OF NEOANGIOGENESIS Boswellia/Curcumin Sea Cucumber Extract Devils Claw Yucca Schidigera Extract Omega-3 polyunsaturated fatty acids - fish oil - krill oil - green lipped muscle extract lyprinol 15. PLATELET-RICH PLASMA THERAPY (PRP) Platelet attachment to collagen fibers results in their activation and massive release of growth factors Released growth factors stimulate cartilage matrix synthesis and suppress inflammatory responses Published data indicate that PRP therapy benefits patients with knee and hip OA 16. PHYSICAL THERAPY TREATMENT METHODS Iontophoresis with acetic acid Class IV laser therapy Manual therapy Pilates based rehab exercises 17. IONTOPHORESIS WITH ACETIC ACID Reduce calcific deposits and bone spurs Insoluble calcium in the form of calcium pyrophosphate reacts with acetic acid to form calcium acetate, which is more soluble and therefore, more easily dissolved by our body fluids (synovial fluid, blood) 18. CLASS IV LASER THERAPY Reduce pain, inflammation, and enhance tissue healing of muscle, ligaments and bones Increase circulation and oxygenation of tissues >RBCs to area and increasing venous and lymphatic return Non-invasive use of laser energy to generate a photochemical response (helping cells produce ATP/energy) in damaged or dysfunctional tissue 19. LASER THERAPY 20. MANUAL THERAPY Reduce pain, increase joint range of motion, increase joint proprioception and increase muscle length Passive physiological and accessory movements, manual muscle stretching and soft tissue mobilization 21. PILATES BASED REHAB Benefits: o increases range of motion o increases flexibility o increases strength o increases spine stabilization o improves balance o improves posture o enhances body awareness o decreases joint stress o enhances breathing Joseph Pilates: exercise format embodying complete coordination of body, mind and spirit 22. PILATES 23. PRESENTATION MATERIALS Slides available on slideshare.com/ifsmed Video available on youtube.com/ifsmed THANK YOU FOR COMING!