What is Osteoarthritis Overview of osteoarthritis Osteoarthritis is a condition in which the articular cartilage that normally provides a smooth, stable surface, begins to fail leading to breakdown. This compromises the normal smooth, painless functioning of the joint surfaces. The most common cause of osteoarthritis is aging. However, a number of other factors can lead to osteoarthritis including genetic predisposition, gender, joint injury, obesity and overuse. As the cartilage tissue begins to fail, small inflammatory molecules are released into the joint environment which results in inflammatory reaction in joint tissues, most notably the synovium. This inflammatory reaction leads to aching pain, swelling, weakness and stiffness. This inflammation accounts for most of the symptoms experienced by patients with osteoarthritis. Some patients may also experience mechanical symptoms such as crunching, grinding or locking that are caused by unstable fragments of cartilage, loose bodies or unstable soft tissue problems such as meniscus tears. There are a wide range of treatment options that can be effective for osteoarthritis including weight loss, exercise, physiotherapy, pain medication, anti-inflammatory medication, injectable therapies and surgical options. Central role of inflammation It has become apparent that most human disease processes are driven by inflammation. Osteoarthritis is no exception. The broken-down molecules that are released into the joint as cartilage begins to fail, leads to inflammatory changes in the synovium, which is the tissue that lines the joint. This inflammatory reaction drives symptoms such as: Pain; Aching; Swelling; Weakness; Stiffness. Increasingly, the treatment of osteoarthritis has focused on managing inflammation. If the inflammatory reaction of the synovium can be effectively treated, patients can function well with little or no symptoms despite having significant underlying osteoarthritis damage. Mechanical Symptoms Although inflammatory symptoms are more common, some patients have mechanical symptoms which can range from relatively mild clicking to much more significant symptoms such as crunching, grinding or in extreme situations locking or mechanical seizing up of the joint. Patients who have marked mechanical symptoms such as crunching, grinding and locking may require surgical intervention. Initial Triage On initially assessing a patient with osteoarthritis, it is important to determine whether or not there are significant mechanical symptoms which require surgical intervention. Fortunately, most patients do not have marked mechanical symptoms. Thus, surgery does not need to be the initial form of treatment for the vast majority of patients. Most patients presenting with osteoarthritis symptoms can be managed with safer, less invasive therapies that are directed at reducing inflammation. Click here to find more information on non-clinical treatment options

nSTRIDE nSTRIDE is a relatively new biologic therapy that is also based on manipulating human biology but is very different in its mechanism of action. In simple terms, the patient's blood is collected and processed. The anti-inflammatory proteins, referred to as IL-1 antagonists, are isolated and then injected back into the affected joint. One key difference between nSTRIDE and PRP is the number of injections. nSTRIDE treatment is delivered with a single injection vs. three for PRP. Clinical study results have shown that the single nSTRIDE injection can provide relief for up to 24 months, which is longer than other available treatments. Relief of pain typically comes within 1 to 2 weeks of the injection. Product details are available in this brochure and post-treatment details are available here . nSTRIDE is approved for use in Canada for knee osteoarthritis. Recently published clinical study results, showing favourable progress of study participants across a three year monitoring period, can be found at this link: https://pubmed.ncbi.nlm.nih.gov/32870042/ .

Physiotherapy & Braces Physiotherapy is a very important and effective tool for managing OA. The central focus of physiotherapy is on maintaining range of motion and strength of the joint, both of which can be compromised. The timing of the physiotherapy is very important. If aggressive PT is pursued in an actively inflamed joint, the therapy may exacerbate the inflammatory process, making symptoms worse. The preferred approach is to bring the inflammatory symptoms under control, then subsequently introduce the range of motion and strengthening PT programme. ​ Braces provide stability for the affected joint and increase confidence in its use. When used correctly and consistently, braces have been shown to reduce OA symptoms and improve joint function.

Exercise & Weight Loss Regular exercise and maintaining a healthy weight can together help to prevent the onset of osteoarthritis (OA) and help to manage existing symptoms. When suffering from OA, excess weight increases the strain on damaged cartilage tissue, which in turn contributes to a worsening of symptoms and acceleration of the underlying disease process. Conversely, losing weight has the potential to decrease the severity of OA symptoms and slow down the progression of the disease. ​ Low impact exercises, performed regularly, are helpful for managing OA. Example exercises include yoga, tai chi, biking, walking, and pool aerobics. Building muscular strength through exercise can help support the joints and slow further disease onset. Patients should talk to their doctor before starting any new exercise routine. ​ Unfortunately, by the time many patients seek treatment for OA, their symptoms are sufficiently severe that it is more difficult to exercise in order to lose weight. In these cases, it is necessary to first initiate therapies that decrease the severity of the OA symptoms so that the patient can then subsequently increase their exercise programme in order to lose weight and further reduce disease progression. The importance of healthy weight, diet, and exercise as part of OA management cannot be overstated.

COVID-19 Notice Comprehensive Arthritis Management, Inc. is in compliance with orders pertaining to medical practices in Ontario. The health and safety of our patients is our top priority. We have implemented specific protocols and procedures to keep patients and staff as safe as possible while attending to those with medical needs, including the following: ​ • Wait-rooms and other areas have been modified to provide physical distancing • Hand sanitizer is available at front reception and throughout the clinic • All patients arriving without a mask are provided one • Touch surfaces throughout the clinics are regularly sanitized, and any extraneous items have been removed ​ Standards and requirements are subject to change based on updates provided from government and health agencies. ​ For further information on COVID-19, please visit https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus Return to Site

Hyaluronic Acid Hyaluronic acid (HA) gels have been available for twenty-five years. They are a very safe therapy that works by decreasing joint inflammation and lubricating the joint surface. Although there is a wide degree of variability in their effectiveness in any individual patient. Specifically, they are typically effective in approximately 50-60% of patients, provide symptom relief of approximately 40% and typically last around 6-12 months. Hyaluronic acid gel therapies are moderately expensive but are now covered on many third-party insurance plans. While there are a large number of HA product options available, Comprehensive Arthritis Management utilizes a HA gel product called Synvisc given its good track record of quality and efficacy. Additional information on the hyaluronic acid product used by CAM are available by clicking here .

Platelet Rich Plasma (PRP) This therapy represents the first biologic therapy available for the management of OA. Biologic therapies generally manipulate normal human biology in order to treat disease, rather than using drugs. In the case of PRP, a blood sample is taken from the patient’s arm and placed into a centrifuge which allows the blood to be separated into two layers. The top, lighter layer contains platelet cells that are suspended in the plasma. The lower portion of the sample contains red cells and white cells which cause inflammation and are discarded. The plasma with the suspended platelets is injected into the patient's knee and the injected platelets release a large number of anti-inflammatory and growth factor molecules into the joint environment. PRP is effective in diminishing inflammation and OA symptoms, shown in clinical study to decrease symptom severity by 78%. The benefit lasts in excess of one year, with many patients achieving multiple years of improvement before the effectiveness fades. Key clinical study results are reported here: https://pubmed.ncbi.nlm.nih.gov/26831629/ There are some forms of PRP injections that include white cells in part of the injectable cells, but 'leukocyte poor' PRP, in which the white cells are removed, is considered to be more effective than the leukocyte rich form of PRP. CAM uses a specific type of leukocyte poor PRP injection called autologous conditioned plasma (ACP) for its treatments. For more information on the PRP product used by CAM, click here .

Alternative Medicine There are a variety of alternative medicine options available that may help manage OA symptoms. The success of these options is very specific to the individual and often difficult to predict, but when they work for a patient it can be very positive especially if more invasive treatments are avoided. Given their generally low risk, individuals with chronic OA should certainly consider the alternative medicine options they are comfortable with, in consultation with their doctor. General categories of these treatments include the following: ​ Acupuncture . This is an eastern medicine practice involving the placement of fine needles at specific points on the body. Clinical studies on their efficacy are generally mixed, but there is some evidence of help for managing pain from OA. [1 ] ​ Supplements . A number of popular supplements, such as glucosamine chondroitin, and omega-3, are used to manage the effects of OA. While clinical studies on their efficacy of OA are also mixed, some benefits can be achieved. Be sure to speak to your physician before starting supplements, as they may interact with medications or affect other unrelated conditions. Cannabinoids . The medicinal use of marijuana has been expanding in recent years. The active ingredients CBD and THC, used individually or in combination, do provide OA pain and symptom relief for some patients. There is a limited but growing body of information on the proper dosing and efficacy of cannabis products.

Corticosteroid Corticosteroid injections have been available for around fifty years. Used appropriately, they are effective at treating joint inflammation. They also have the advantage of being relatively inexpensive compared to other treatment options. However, their effect is generally short-lived, which limits their utility as a therapy for chronic aging-related OA. ​ Corticosteroids are most useful in managing acute inflammatory flares and post-surgical inflammation. They must be applied judiciously since they have the potential for causing cartilage damage if used inappropriately or excessively. But when used appropriately, they play an important role in OA management.

Partial Joint Replacement A partial knee replacement is a surgical procedure where either the inside or outside compartments of the knee or other joint are removed and replaced with a prosthesis. This differs from a total joint replacement where all compartments are removed and replaced. Knee replacement surgery, the most common form of joint replacement, has benefits that typically last about 20 years, so younger patients should be aware that additional future surgery may be required. Partial knee replacement is similar to total knee replacement in terms of the benefits, risks, and potential outcomes (see total joint replacement description for more details). There is increasing concern that partial joint replacements do not hold up as well as total joint replacement, and revision surgery, if required, is more complex. Together, these options require careful consideration by an experienced surgeon, and alternative options should be explored before selecting surgery.

Total Joint Replacement Total knee replacement is a surgical procedure in which the osteoarthritic cartilage and adjacent underlying bone are removed and metal and plastic prostheses are cemented into place. This is a thirty-year-old technology that revolutionized the management of arthritis. However, it is very invasive, expensive, and comes with a risk of significant complications. The results can be very positive, but for some patients, they can be poor. Multiple studies have documented that 12-20% of patients are dissatisfied with their outcome [1 ,2 ]. Given the potential for an unfavorable outcome, it is important to ensure that alternatives to surgery have been explored with your doctor. Another important risk to be aware of is the potential for post-operative opioid addiction. U.S. study data indicates that total knee replacements have the second-highest rate of opioid use among all surgery types performed and a 15.2% chronic opioid addiction rate after total knee replacement. [3 ] Although joint replacement has been life-changing for many patients, it should be considered as a last resort given its invasiveness and risk.