Anyone know anything about drugs for Osteo arthritis?

[LaurieFairyCake]

I've just had a GP appointment and she's going to chat to the Pain team and a pharmacist about what's possible.

I can't take NSAIDS due to stomach surgery, steroid injections have stopped working (in knees). I already take gabapentin for sciatica but it does nothing for knees.

What's left? I asked about Diclefonac and she said it was just high dose ibuprofen and not used anymore.

I have arthritis in both knees, one hip, and one foot. I'm massively struggling to walk up stairs - crawling quite a bit - loads of pain now. No problems walking on the flat or going DOWN stairs.

diclofenac and naproxen are nsaids, so probably to suitable for you.

has the gp referred you to a rheumatologist? if not you need to ask for a referral as soon as possible. a rheumy can discuss other options (methotrextate, biologics) with you.

physio had good results for pain relief.

Sorry to be thick - but a rheumatologist for osteo arthritis?

rheumatologists deal with inflammatory diseases of the skeleton.

good luck!

Thank you so much for that

Genuinely thought they only dealt with rheumatologist arthritis

An orthopaedic surgeon would be a usual referral too? To consider joint replacement surgery which could resolve a lot of those problems.

Paracetamol?
Topical NSAIDs could be an option
OA is different from inflammatory arthritis

Paracetamol and topical application does nothing at all. I have very little cartilage left in one knee

The doc said I'd have to be immobile to even start the journey towards joint replacement- there's a 5 year wait

I'm also quite young at 50

I don't have arthritis but I have joint problems in my pelvis and facet joints. I've had steroids injected to bring down inflammation - is this an option for arthritis?

Agree rhematologist would be good to see.

I went private so not sure what's possible through NHS but worth asking.

I was on naproxen and codeine for the pain

Yes, I've been paying for private steroid injections for last 18 months and unfortunately now they've stopped working - I was getting 8 weeks out of them, now they're only lasting 2 weeks

The doc said I'd have to be immobile to even start the journey towards joint replacement- there's a 5 year wait

That’s not ok. I’d get a second opinion, many surgeons will operate on younger people.

I had joint replacements for osteo arthritis in my 30s. Your life is being seriously impacted by it. They’re life changing.

There is no medication for osteoarthritis other than painkillers.
Really, other than surgery the best things you can do are keep your weight under control (even just tipping over BMI25 will increase the strain on your joints) and regular exercise (non weight-bearing such as swimming or cycling is best).

Some people do have some success with hyaluronic acid injections, but there's not really any scientific evidence they work. It could be worth discussing them with you doctor.

Ultimately, though, joint replacement surgery is the only long-term solution, but 50 is very young to be considering it.

I've just spent £17k on bariatric surgery to get down to as low a weight as possible

I just need some good drugs for the next year (hopefully!)

I've been offered the hyaluronic acid injections by the guy who does my steroids

He said they work for about 30% of his patients. But they're twice the cost of the steroid ones so I've not been tempted yet.

Definitely push to see a Rheumatologist, i did for my OA.. being specialists they'll know more then your GP about your options surely?

I had heard steroids stop working after @ 2 years on average

Unless there's any evidence of inflammatory arthritis (which you GP should consider excluding), it is an orthopaedic surgeon you need, not a rheumatologist

Sounds like you need to really push for knee replacement - if you wait years it will be much more difficult to recover from and will impact on other areas including your back if you can't walk properly.

Could you go private? Maybe if you just go for initial consultation and diagnosis the consultant might be able to put pressure on the GP to put you forward as soon as possible. Good luck.

You don’t need to go private to get a joint replacement on the NHS, it’s not that unusual.

Butrans pain patch? Lasts a week

Opiods (butrans) for chronic pain like this not recommended.
An Ortho opinion would be good, I wouldn't write surgery off as an option before discussing with a surgeon. Even if they just lay out your options or how to optimise yourself to be in the best position. But people with your age and high BMIs have joint replacements. It can be a bit more complex but the other option is leaving people with poor mobility and pain so if course it's an option.

@LaurieFairyCake

Yes, I've been paying for private steroid injections for last 18 months and unfortunately now they've stopped working - I was getting 8 weeks out of them, now they're only lasting 2 weeks

Dear God, how many injections have you had in 18 months? Steroid injections can damage cartilege and should be seriously rationed. To be honest, if the effect is only for 8 weeks then it would be clinically perverse to continue the injections - maybe, but only a second one at some stage, but no more than that. They may have done more harm than good.

Whilst I agree that joint replacement on the NHS is not unusual - assuming that it is the best option, and without knowing a lot more about you, it may not be the right option - the waiting lists pre-Covid were unbearably long, and they haven't improved any in the last year.

It is also not true that there is no medication for osteoarthritis other than painkillers - that is so old-fashioned a view that I thought most people had realised how unhelpful that opinion is. I suspect the problem that you have has got more to do with the variety of issues and existing medications, and not setting up more problems on top of what you already have. I do think the GP has the cart before the horse though - before a referral for pain management I would have thought a specialist appointment was called for - pain management is often the last resort when there is nothing else that they can explore, and if you haven't seen a specialist, given how bad the presentation is, I would have thought that a better option. What you are describing is beyond the expertise of most GP's and pharmacists; and unless your pain management service is highly resourced, it probably consists of a nurse and a psychologist - both very skilled but their primary aim is to support your approach to pain, not to medicate it.

clearly I haven't been clear

I've only been having them the length of time you're allowed to have them - you're only allowed steroid injections every 12 weeks (I've had 5 lots so far)

At the beginning (18 months ago) the first lot lasted 8 weeks. The last lot I had only lasted 2 weeks. I had 6 months without them due to Covid (that's what prompted the bariatric surgery)

I'm trying to find out more info for my mum. She is 65 and suffered for over a decade. She takes what you mention above and tramodol I believe but sometimes it doesn't touch the pain.

She has been offered injections and surgery on her hands but advised to wait until corona is over.

I'm looking for other ideas as she has done pain management stuff a few times but needs something more.

Do you have inflammation markers in your bloods as she does not.

You need to try a really good green lipped mussel product - there is so much evidence out there that it works and having taken some myself (and I’m very wary of taking supplements!) they do make a massive improvement.

If the waiting lists are unbearably long, best get on it ASAP if that’s the solution which will only be worked out via referrals to the right specialist.

I haven’t found any benefit from dietary supplements. My problem is largely jagged edge bone rubbing against another jagged edge bone so it’s no wonder really.