What are the initial management strategies for Degenerative Joint Disease (DJD)?

From the Guidelines

Initial management of Degenerative Joint Disease (DJD) should focus on non-pharmacological approaches, including physical therapy, heat/cold, orthotics, and weight loss for overweight patients, as recommended by the most recent and highest quality study 1. The goal of these approaches is to reduce pain and improve function, while minimizing the risks associated with pharmacological interventions.

• Non-pharmacological approaches should be individualized to the patient's needs and preferences, taking into account their physical status, activities of daily living, participation, mood, and health education needs 1.
• Weight loss, if necessary, can reduce joint stress by 3-4 pounds for each pound lost, particularly in weight-bearing joints.
• Physical therapy and regular low-impact exercise, such as swimming, cycling, or walking, are essential to maintain joint mobility and strengthen supporting muscles.
• Assistive devices, including canes, braces, or orthotic inserts, can reduce joint stress during daily activities.
• Heat and cold therapy applied for 15-20 minutes several times daily can alleviate pain and reduce inflammation. If pharmacological treatment is necessary, acetaminophen should be considered as the first-line treatment, starting at 500-1000mg every 6 hours, not exceeding 3000mg daily, due to its minimal side effects 1. For more significant pain, NSAIDs such as ibuprofen or naproxen may be used, though with caution in patients with cardiovascular, renal, or gastrointestinal conditions 1. It is essential to note that the treatment of DJD should be tailored to the individual patient's needs and preferences, and that a regular review and adjustment of the treatment plan is necessary to ensure optimal outcomes 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Rheumatoid arthritis and osteoarthritis, including flare-ups of chronic disease: Suggested Dosage: 1200 mg to 3200 mg daily (400 mg, 600 mg or 800 mg tid or qid).

The initial management strategies for Degenerative Joint Disease (DJD), also known as osteoarthritis, include:

• Using the lowest effective dose of ibuprofen for the shortest duration consistent with individual patient treatment goals
• Starting with a suggested dosage of 1200 mg to 3200 mg daily (400 mg, 600 mg or 800 mg tid or qid)
• Adjusting the dose as needed to suit an individual patient's needs, with the goal of using the smallest dose that yields acceptable control 2

From the Research

Initial Management Strategies for Degenerative Joint Disease (DJD)

The initial management strategies for DJD can be categorized into several approaches:

• Conservative management: This is the cornerstone for the treatment of most DJD cases 3. Conservative management includes the use of analgesic and anti-inflammatory drugs, physical therapy, and exercises to maintain muscle strength, joint stability, and mobility 4.
• Medical management: Medical management is successful in the majority of patients until the active degenerative phase burns out 5.
• Use of stabilizing splints: Stabilizing splints are a common conservative treatment in managing TMDs symptoms and can contribute to favorable adaptive changes in the condyles 6.
• Regenerative therapies: Regenerative therapies, such as the use of a regenerative gel obtained with distressed, processed blood, polydeoxyribonucleotides (Pdrn), and a thickening substance, can stimulate local innate stem cells to induce tissue repair 7.

Key Considerations

When managing DJD, it is essential to consider the following:

• The severity of the disease and the patient's expectations and level of activity should guide treatment decisions 4.
• A diagnostic algorithm can help control DJD in the TMJ 3.
• The etiopathogenesis of osteoarthritis is complex and associated with multiple risk factors, including biomechanical, metabolic, genetic factors, inflammation, and other risk factors 4.

Treatment Goals

The primary goals of treatment for DJD are to:

• Reduce pain and improve joint mobility 7.
• Maintain muscle strength, joint stability, and mobility 4.
• Restore mandibular function and form in patients who have lost it secondary to degenerative joint disease affecting the glenoid fossa/mandibular condyle unit 5.