What is the treatment for active arthrosis in the feet?

From the Guidelines

Treatment for active arthrosis in the feet typically involves a combination of conservative measures and medications, with a strong recommendation for exercise, weight loss, and topical nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line treatments, as suggested by the 2019 American College of Rheumatology guideline 1. Initial treatment includes weight management to reduce pressure on foot joints, appropriate footwear with good arch support and cushioning, and activity modification to avoid high-impact exercises. Over-the-counter pain relievers such as acetaminophen (Tylenol) at 325-650mg every 4-6 hours (not exceeding 3000mg daily) or NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) can help manage pain and inflammation. Physical therapy focusing on foot and ankle exercises to maintain mobility and strengthen supporting muscles is beneficial. Custom orthotic inserts can redistribute pressure and improve foot alignment. For more severe pain, corticosteroid injections (such as methylprednisolone 40mg or triamcinolone 40mg) directly into affected joints may provide temporary relief for 1-3 months. Topical analgesics containing capsaicin or diclofenac can offer localized pain relief. These treatments work by reducing inflammation, managing pain signals, and supporting damaged joint structures. In advanced cases unresponsive to conservative treatment, surgical options like joint fusion (arthrodesis) or joint replacement may be considered. Some key points to consider in the management of osteoarthritis include:

• Weight loss for patients who are overweight or obese, as recommended by the 2019 American College of Rheumatology guideline 1
• Exercise and physical therapy to maintain mobility and strengthen supporting muscles
• Use of assistive devices, such as canes or orthotics, to reduce stress on affected joints
• Topical NSAIDs for localized pain relief
• Intraarticular corticosteroid injections for temporary relief of severe pain
• Surgical options, such as joint fusion or replacement, for advanced cases unresponsive to conservative treatment. It's worth noting that the American College of Rheumatology guideline 1 provides a comprehensive approach to the management of osteoarthritis, and healthcare providers should consider the individual patient's needs and preferences when developing a treatment plan.

From the FDA Drug Label

Temporarily relieves minor aches and pains of muscles and joints due to: simple backache arthritis strains, sprains The treatment for active arthrosis in the feet may include topical capsaicin to temporarily relieve minor aches and pains of muscles and joints due to arthritis 2.

• Capsaicin (TOP) is used for temporary relief of minor arthritis pain.
• However, it is essential to note that the label does not explicitly mention feet or active arthrosis, so this answer is based on the assumption that arthritis pain relief can be applied to active arthrosis in the feet.

From the Research

Treatment Options for Active Arthrosis in Feet

The treatment for active arthrosis in the feet involves a combination of pharmacological and non-pharmacological approaches. Some of the treatment options include:

• Analgesics such as paracetamol or low-dose ibuprofen for mild-to-moderate pain in noninflammatory arthrosis 3
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation, with the option of using COX-2 inhibitors to minimize gastrointestinal side effects 3, 4
• Intra-articular corticosteroid injections for individual inflamed active joints 3, 5
• Hyaluronic acid and chondroprotectors, which are commonly used in the treatment of osteoarthritis, especially in older subjects with advanced osteoarthritis 6
• Opioids, which may be necessary in addition to NSAID treatment for chronic pain 3, 7

Pharmacological Treatment

Pharmacological treatment is a crucial aspect of managing active arthrosis in the feet. The goal of pharmacotherapy is to alleviate symptoms such as pain and improve the quality of life. Some of the pharmacological treatment options include:

• Oral nonsteroidal anti-inflammatory drugs (NSAIDs) 5
• Topical NSAIDs 5
• COX-2 inhibitors 4, 5
• Acetaminophen (paracetamol) 3, 7, 5
• Tramadol 7, 5
• Capsaicin 5

Considerations for Treatment

When considering treatment options for active arthrosis in the feet, it is essential to take into account the individual patient's needs and medical history. Some factors to consider include:

• The presence of inflammation, which may require the use of NSAIDs or intra-articular corticosteroid injections 3, 5
• The risk of gastrointestinal side effects associated with NSAIDs, which may require the use of preventive measures such as PPI or COX-2 inhibitors 3, 4
• The potential benefits and risks of each treatment option, including the efficacy and safety of the medication 7, 5