How Osteoarthritis Is Treated

Treatment for osteoarthritis (OA) is usually multi-faceted and depends on the joint (or joints) affected and other individual factors. 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 prescription drugs; and surgical joint replacement.

These treatments can work together to relieve the underlying inflammation and the symptoms of osteoarthritis—joint pain, stiffness, and swelling. In addition, goals of osteoarthritis treatment include preserving or improving joint function, minimizing disability, and improving quality of life.

Home Remedies and Lifestyle

Several lifestyle strategies can help reduce the pain and other symptoms of osteoarthritis. Some of these measures may also help to slow the progression of cartilage loss.

Your healthcare provider's recommendations will depend on the stage and extent of your disease, and can include:

• Gentle exercise: Walking, biking, and swimming and other forms of water exercise are safe and effective physical activities for people who have 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 if you are overweight. 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) to the affected joints.
• Supportive devices: Knee braces, specialized footwear, insoles, and splints can help give support and stability to affected 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 can provide balance support for some people who have osteoarthritis.

Over-the-Counter (OTC) Therapies

Over-the-counter drugs can help reduce mild to moderate pain and inflammation of osteoarthritis. If you aren't sure which OTC medications to try, ask your healthcare provider or 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 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 the discomfort of osteoarthritis, 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 healthcare provider advises and don't use it if you have liver disease.

Topical Pain Relievers

Medicated creams, balms, ointments, and patches can be applied directly to affected joints. These treatments are most suitable for small areas of osteoarthritis—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.

Prescriptions

Your healthcare provider might recommend a prescription medication to help relieve your osteoarthritis pain.

Prescription NSAIDs

These are stronger medications than those that are available over the counter:

• Celebrex (celecoxib)
• COX-2 inhibitors

Opioid Pain Relievers

Weak opioids and narcotic analgesics may be prescribed for osteoarthritis pain in some situations (such as inability to tolerate NSAIDs). Ultram (tramadol) is an example.

Opioid medications reduce pain, but not inflammation. Because of the risk of dependency, these medications can only be used with extreme caution.

Surgeries and Specialist-Driven Procedures

When the joint is severely damaged and repairable, sometimes an interventional procedure can be beneficial.

Procedures can include:

• Intra-articular (into the joint) injections of corticosteroids
• Unicompartmental knee replacement
• Osteotomy and other surgical procedures to preserve joints
• Joint fusion (sometimes considered after a joint replacement has failed)
• Joint lavage (washout) and arthroscopic debridement (for knee osteoarthritis)

Total joint replacement is also an option but is usually 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 managing symptoms of osteoarthritis, including:

• Acupuncture
• Cognitive behavioral therapy
• Reflexology
• 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 healthcare provider, as they will base their guidance on the general recommendations with special consideration to your individual symptoms and disease severity.

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.

• 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 experience symptom improvement with conservative treatments. If conservative measures fail, however, surgical options may include lumbar laminectomy, discectomy, or spinal fusion.
• Foot osteoarthritis symptoms can be relieved with orthotics or foot supports. 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. Arthroscopy, arthrodesis (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.