How Osteoarthritis Is Treated

Treatment for osteoarthritis (OA) typically is a multi-faceted undertaking in which a variety of options are used, depending on the joint (or joints) affected and other individual factors. Those options include (but aren't limited to) home remedies and lifestyle modifications such as hot or cold therapy and exercise; over-the-counter (OTC) pain medications or stronger prescription drugs; and surgery to replace severely damaged joints.

These treatments are designed to work together to relieve inflammation and the symptoms it causes—joint pain, stiffness, and swelling. In addition, osteoarthritis treatment is targeted toward helping to preserve or improve joint function, minimize disability, and improve quality of life.

Senior Couple Strolling
Ronnie Kaufman / Corbis / Getty Images

Home Remedies and Lifestyle

Among the non-pharmacologic (non-drug) treatments for arthritis are a variety of ways to maintain a lifestyle that helps reduce the pain and other symptoms of osteoarthritis. Some of these measures may also help to slow progression of cartilage loss. Your doctor may recommend some of these for you immediately; they may suggest you try others if your OA progresses:

  • Gentle exercise: Walking, biking, and swimming and other forms of water exercise are safe and effective physical activities for people with arthritis.
  • Weight loss: Excess pounds put added strain on weight-bearing joints. According to the Centers for Disease Control and Prevention, a modest reduction in weight can be highly beneficial. For example, every pound lost adds up to a four-pound reduction in weight load on the knees.
  • Hot/cold therapies: Also known as thermal modalities, these are simple strategies that involve applying heat (with a heating pad, for example) or cold (such as with an ice pack), directly to affected joints.
  • Supportive devices: Knee braces, specialized footwear, insoles, and splints can help give support and stability to certain joints.
  • Kinesiotaping: This involves using a special type of tape available over the counter that adheres to the skin and can be positioned to support joints.
  • Walking aids: Walking aids like canes, walkers, and motorized scooters provide balance support.

Over-the-Counter (OTC) Therapies

Over-the-counter drugs can help reduce mild to moderate pain and inflammation caused by osteoarthritis. If you aren't sure which OTC medications to try, ask your doctor of pharmacist for recommendations.

Oral NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation.

They include:

  • Aspirin (only appropriate for adults; aspirin is unsafe for children and teens due to a risk of a serious disease called Reye's syndrome)
  • Ibuprofen (Advil and others)
  • Ketoprofen
  • Naproxen (Aleve and others)

NSAIDs can be hard on the stomach and can irritate the digestive tract, especially when used long-term.

Acetaminophen

Acetaminophen is the active ingredient in Tylenol. It works by blocking impulses that send pain signals to the brain. While it can ease discomfort, it does not reduce inflammation.

Acetaminophen has few side effects when taken as directed. Too much can cause liver damage, though, so don't take more than your doctor advises.

Topical Pain Relievers

Medicated creams, balms, ointments, and patches that are applied directly to affected joints are most suitable for small areas—a few knuckles of the hand rather than the entire back and hips, for example.

Topical pain relief products are available by prescription as well as over the counter and contain a variety of different active ingredients.

Examples of Topical Medications for Arthritis
Medication Active Ingredient  Rx?  OTC?
Voltaren Diclofenac 1% gel  
Flector Diclofenac epolamine 1.3% patch
Pennsaid 1.5% liquid or 2% liquid

Bengay
Lidocaine   
Aspercreme Lidocaine
Aspercreme Pain Relieving Creme Lidocaine plus trolamine salicylate  
Aspercreme Warming Patch Lidocaine plus capsaicin
Tiger Balm Camphor and menthol (counterirritants)
Icy Hot Original Lidocaine plus menthol or salicylate
Salonpas Pain Relieving Hot Patch Capsaicin

Prescriptions

When over-the-counter treatments aren't enough, prescription medications are needed to help relieve osteoarthritis pain.

Prescription NSAIDs

These are stronger versions of what you can get over the counter:

The American College of Rheumatology (ACR) suggests people with osteoarthritis who are 75 or older use topical NSAIDs rather than oral NSAIDs.

Opioid Pain Relievers

Weak opioids and narcotic analgesics may be prescribed for osteoarthritis pain that isn't responding to other medications. Ultram (tramadol) is an example.

Opioid medications reduce pain, but not inflammation. Because of the risk of dependency, these medications should only be used if the benefits outweigh the risk.

Being Researched

Researchers are working on developing disease-modifying osteoarthritis drugs (DMOADs), which are intended to slow disease progression similarly to disease-modifying antirheumatic drugs (DMARDs) for inflammatory types of arthritis.

Surgeries and Specialist-Driven Procedures

When lifestyle modifications and medication do not work well enough, less-conservative measures may be necessary, among them:

Total joint replacement is an option, but should be considered only after all other treatments have failed.

Complementary/Alternative Medicine (CAM)

A number of alternative treatments have been found to be effective adjuncts to conventional therapies for treating osteoarthritis, including:

  • Acupuncture
  • Cognitive behavioral therapy
  • Tai chi
  • Yoga (for knee arthritis)

Recommendations for Specific Joints

An expert panel convened by the American College of Rheumatology and the Arthritis Foundation issued detailed recommendations for treating osteoarthritis of the hand, knee, and hip in 2019, based on these levels of recommendation:

  • Strongly recommended based on high-quality evidence that greatly favors benefits over risks associated.
  • Conditionally recommended based on a lack of sufficient, high-quality evidence or evidence that was less distinct when weighing benefits versus risks.
  • Strongly recommended against
  • Conditionally recommend against

Although the ACR/AF guidelines focus on the hand, knee, and hip, some of them may pertain to other joints, such as the spine and shoulder.

That said, it is important to always follow the advice of your doctor or rheumatologist, as they will base their guidance on your individual symptoms and severity of joint deterioration as well as on the general recommendations.

Hand Hip Knee
Strongly recommended Exercise Self-efficacy/self-management programs Hand orthosis (for the first carpometacarpal joint, or CPC joint) Exercise Weight loss Self-efficacy/self-management programs Tai chi Cane Exercise Weight loss Self-efficacy/self-management programs Tai chi Cane Tibiofemoral knee brace
Conditionally recommended Cognitive behavioral therapy (CBT) Kinesiotaping of CPC joint Hand orthosis (of joints other than CPC) Acupuncture Hot/cold therapy Paraffin Balance training Yoga CBT  Patellofemoral knee brace Kinesiotaping Acupuncture Hot/cold therapy Radiofrequency ablation Balance training CBT Acupuncture Hot/cold therapy
Strongly recommended against Bisphosphonates Glucosamine  Hydroxychloroquine Methotrexate TNF inhibitors Il-1 receptor antagonists Transcutaneous electrical nerve stimulation (TENS)  Bisphosphonates Glucosamine Hydroxychloroquine Methotrexate TNF inhibitors Il-1 receptor antagonists PRP Stem cell injection Chondroitin TENS Bisphosphonates Glucosamine Hydroxychloroquine Methotrexate TNF inhibitors Il-1 receptor antagonists PRP Stem cell injection Chondroitin Intra-articular hyaluronic acid
Conditionally recommended against  Iontophoresis for CPC Chondroitin Intra-articular hyaluronic acid Topical capsaicin Colchicine Non-tramadol opioids Fish oil Vitamin D Modified shoes Wedged insoles Massage therapy Manual therapy with/without exercise Pulse vibration therapy  Intra-articular hyaluronic acid Prolotherapy Colchicine Non-tramadol opioids Fish oil Vitamin D Wedged insoles Massage therapy Manual therapy with/without exercise Protherapy Colchicine Non-tramadol opioids Fish oil Vitamin D
Adapted from 2019 American College of Rheeumatology/Arthritis Foundation Guideline for Management of Osteoarthritis of the Hand, Hip, and Knee

Other Joints

Although the feet and spine, as well as other joints, were not included in the ACR's treatment recommendations, many of the guidelines apply to any affected joint—especially pharmacologic recommendations.

Osteoarthritis of the spine occurs when there is deterioration in the discs between the vertebrae. Most people with degenerative disc problems do not require surgery and are helped adequately by conservative treatments. If conservative measures fail, however, surgical options may include lumbar laminectomy, discectomy, or spinal fusion.

As with the other joints, the goal treating of foot osteoarthritis is symptom relief. Orthotics or foot supports may be helpful. Weight loss can literally take a load off of feet and other weight-bearing joints.

If conservative options aren't effective, surgery may be considered as a last resort. Arthroscopyarthrodesis (fusion), or arthroplasty (joint replacement) may be considered, depending on the joint involved in the foot or ankle. The goal of foot surgery is to relieve pain and improve joint function.

Frequently Asked Questions

What are the stages of osteoarthritis?

Osteoarthritis (OA) often is classified according to what is called the Kellgren and Lawrence grading system, which is based on X-rays:

  • Grade 0 (none): No evidence of OA
  • Grade 1 (doubtful): Unclear evidence of narrowing of the space between joints; possible osteophytic lipping
  • Grade 2 (minimal): Definite osteophytes (bone spurs); possible joint space narrowing
  • Grade 3 (moderate): Moderate multiple osteophytes; definite joint space narrowing; some sclerosis; possible deformity of bone ends
  • Grade 4 (severe): Large osteophytes; severe narrowing of joint space; severe sclerosis; obvious deformity of bone ends

What activities should I avoid if I have osteoporosis?

Depending on the severity of your OA, you may be advised to stop doing activities that may have played a role in the damage to your joints or are likely to make it worse. For example, if years of running has caused knee OA, you may be able to switch to bike riding. However, regular physical activity is vital to overall health, and exercises that strengthen muscles around arthritic joints can help prevent further damage.

How can I prevent my osteoarthritis from getting worse?

In order to keep damaged joints from degenerating further, the Arthritis Foundation advises people with OA to:

  • Lose weight, if excess pounds appear to be putting excess stress on joint
  • Gently stretch every day, at every opportunity, to help maintain full range of motion of affected joints
  • Warm up before exercise and cool down after
  • Manage stress
  • Maintain a healthy lifestyle—don't smoke, drink alcohol in moderation, eat a healthy diet, and get adequate rest
  • Control blood sugar levels (for those who have diabetes)
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Article Sources
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