How Osteoarthritis Is Treated

Senior Couple Strolling

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There are several osteoarthritis treatment options, which range from lifestyle modifications to medications to surgeries and more. Given the range of effects this disease can have, this is especially good news for patients. People with symptomatic osteoarthritis need effective treatment to control joint pain, stiffness, swelling, and other concerns. In addition, osteoarthritis treatment must help preserve or improve joint function, minimizing disability, and improving quality of life.

Home Remedies and Lifestyle

Optimal treatment for osteoarthritis involves both pharmacologic (drug) and non-pharmacologic (non-drug) treatments. There are steps you can take to create a lifestyle that helps reduce the pain of osteoarthritis. Some may be recommended for you immediately; others may be suggested if your disease progresses:

  • Gentle exercise: Aerobic, muscle-strengthening, and water exercise are all good options.
  • Weight reduction: Excess weight puts added strain on the joints. Weight reduction is recommended when necessary.
  • Thermal modalities: Thermal modalities are simple home remedies that go a long way in reducing osteoarthritis pain. Try heating pads or ice packs on affected joints. Experiment to see what works best for you.
  • Braces and splints: Knee braces, specialized footwear and insoles, and splints, can help give support and stability to your joints.
  • Walking aids: Walking aids like canes, walkers, and motorized scooters are good options for added balance support. Consider them to help you get around with greater comfort and confidence.

Over-the-Counter (OTC) Therapies

There are several over-the-counter drugs that can help reduce pain and inflammation of osteoarthritis. They are best for mild to moderate pain. Ask your doctor to recommend an OTC medication that is most appropriate for your situation.

Oral NSAIDs

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

They include:

  • Aspirin
  • Advil, Motrin (ibuprofen)
  • Orudis (ketoprofen)
  • Aleve (naproxen)

NSAIDs can be hard on the stomach and can cause irritation of 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 stick to the recommended dosage.

Topical Pain Relievers

Topical analgesics are another option to relieve arthritis pain. These come in cream or balm form that you rub into the affected joint. They use various ingredients, like capsaicin, counterirritants, or salicylates, to help dull pain.

Topical pain relievers are most suitable when just a few joints are affected (a few knuckles on your hand rather than your entire back and hips, for example).

Brands include:

  • Tiger Balm
  • Bengay
  • Capsasin-HP
  • Icy Hot
  • Aspercreme

Even though these are topical, don't use them more often than is directed.

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. Prescription NSAIDs include:

Older guidelines for the treatment of osteoarthritis were developed prior to NSAIDs being scrutinized for potential heart risks (heart attack and stroke). The association of gastrointestinal side effects and heart risks has caused NSAIDs to be used less.

Osteoarthritis Research Society International (OARSI) committee members say NSAIDs are effective anti-inflammatory drugs and that short-term use may be appropriate when considered on an individual basis. OARSI does not recommend NSAIDs for long-term use without considering a patient's history.

The American College of Rheumatology (ACR) suggests that people with osteoarthritis who are 75 years old 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.

What About DMOADs?

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. While the acronym DMOAD is already being used, the development and marketing of an effective drug of this type is still eagerly awaited.

Surgeries and Specialist-Driven Procedures

Procedures or surgeries may be considered in advanced cases of osteoarthritis, usually as a last resort. There are various options that can help improve stiffness and mobility, and bring pain relief. They include:

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

Complementary Alternative Medicine (CAM)

These should not be used as a replacement for conventional treatment but may help when used along with the treatment plan your doctor has devised for you.

Recommendations by Joint

There is not one solution for everyone, but researchers have produced guidelines for the treatment of osteoarthritis. Treatment varies depending on the joints involved.

In 2012, the ACR published pharmacologic and non-pharmacologic treatment recommendations for the hand, hip, and knee. The panel of clinical experts offered three levels of recommendation for specific treatment options:

  • Strong recommendation: High-quality evidence was required, as well as evidence that greatly favored benefits versus any risks associated with treatment.
  • Conditional recommendation: There is a lack of sufficient, high-quality evidence or evidence that was less distinct when weighing benefits versus risks/
  • No recommendation: There is inadequate data or no data from randomized, controlled clinical trials.

These recommendations are based on evidence that was available through 2010. The expert panel included primary care physicians, physiatrists, geriatricians, rheumatologists, an orthopedic surgeon, as well as physical therapists and occupational therapists. The assembled panel provided a multidisciplinary perspective to thoroughly evaluating the evidence.

The recommendations are important because there are so many treatment options for osteoarthritis—and a suggestion regarding where to begin is necessary. Most people diagnosed with osteoarthritis utilize a combination of pharmacologic and non-pharmacologic treatment options.

Hand

The ACR made no strong recommendations for any treatments for osteoarthritis of the hand.

Hand Osteoarthritis Treatments
Type Option ACR Recommendation
Non-pharmacologic Joint protection techniques Conditional for use
Non-pharmacologic Assistive devices Conditional for use
Non-pharmacologic Thermal modalities Conditional for use
Non-pharmacologic Splints for people with trapeziometacarpal joint osteoarthritis (base of the thumb) Conditional for use
Pharmacologic Topical capsaicin Conditional for use
Pharmacologic Topical NSAIDs, including trolamine salicylate Conditional for use
Pharmacologic Oral NSAIDs, including COX-2 inhibitors Conditional for use
Pharmacologic Ultram (tramadol) Conditional for use
Pharmacologic Intra-articular therapies Conditional for non-use
Pharmacologic Opioid analgesic medications Conditional for non-use

The ACR also conditionally recommends that health professionals (primary care providers, physical therapists, and occupational therapists) evaluate each patient's ability to perform activities of daily living.

Hip

No strong recommendations were made for initial pharmacologic options to treat hip osteoarthritis, but some non-pharmacologic options were granted that status.

Hip Osteoarthritis Treatments
Type Treatment ACR Recommendation
Non-pharmacologic Cardiovascular and/or resistance land-based exercise Strong for use
Non-pharmacologic Aquatic exercise Strong for use
Non-pharmacologic Weight loss (if overweight) Strong for use
Non-pharmacologic Self-management program participation Conditional for use
Non-pharmacologic Manual therapy (massage) combined with supervised exercise Conditional for use
Non-pharmacologic Psychosocial interventions Conditional for use
Non-pharmacologic Thermal modalities Conditional for use
Non-pharmacologic Walking aids Conditional for use
Pharmacologic Acetaminophen Conditional for use
Pharmacologic Oral NSAIDs Conditional for use
Pharmacologic Tramadol Conditional for use
Pharmacologic Intra-articular corticosteroid injections Conditional for use
Pharmacologic Chondroitin sulfate Conditional for non-use
Pharmacologic Glucosamine Conditional for non-use
Non-pharmacologic Balance exercise, alone or combined with strengthening exercises No recommendation
Non-pharmacologic Tai chi No recommendation
Non-pharmacologic Manual therapy alone No recommendation
Pharmacologic Topical NSAIDs No recommendation
Pharmacologic Intra-articular hyaluronate injections No recommendation
Pharmacologic Cymbalta (duloxetine) No recommendation
Pharmacologic Opioid analgesic medications No recommendation

Knee

The recommendations for knee osteoarthritis followed a similar trend.

Type Treatment Option ACR Recommendation
Non-pharmacologic Aerobic exercise and/or resistance land-based exercise Strong for use
Non-pharmacologic Aquatic exercise Strong for use
Non-pharmacologic Weight loss, if overweight Strong for use
Non-pharmacologic Self-management program Conditional for use
Non-pharmacologic Manual therapy combined with supervised exercise Conditional for use
Non-pharmacologic Psychosocial interventions Conditional for use
Non-pharmacologic Medially-directed patellar taping Conditional for use
Non-pharmacologic Medially-wedged insoles (for lateral compartment osteoarthritis) Conditional for use
Non-pharmacologic Laterally-wedged subtalar strapped insoles (for medial compartment osteoarthritis) Conditional for use
Non-pharmacologic Thermal modalities Conditional for use
Non-pharmacologic Walking aids Conditional for use
Non-pharmacologic Tai chi Conditional for use
Pharmacologic Acetaminophen Conditional for use
Pharmacologic Oral NSAIDs Conditional for use
Pharmacologic Topical NSAIDs Conditional for use
Pharmacologic Tramadol Conditional for use
Pharmacologic Intra-articular corticosteroid injections Conditional for use
Pharmacologic Chondroitin sulfate Conditional for non-use
Pharmacologic Glucosamine Conditional for non-use
Pharmacologic Topical capsaicin Conditional for non-use
Non-pharmacologic Balance exercise, alone or combined with strengthening exercise No recommendation
Non-pharmacologic Laterally-wedged insoles No recommendation
Non-pharmacologic Manual therapy alone
 
No recommendation
Non-pharmacologic Knee brace
 
No recommendation
Non-pharmacologic Laterally-directed patellar taping No recommendation
Pharmacologic Intra-articular hyaluronates No recommendation
Pharmacologic Duloxetine No recommendation
Pharmacologic Opioid analgesic medications No recommendation

There also were two treatment options that were conditionally recommended ONLY for people with knee osteoarthritis who have chronic moderate to severe pain and who are candidates for total knee replacement surgery, but are unwilling or unable to undergo the procedure:

Other Joints

While 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 they 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, treatment of foot osteoarthritis targets the relief of symptoms. Wearing orthotics or foot supports may be helpful. Losing weight if overweight will help all weight-bearing joints. If conservative treatment options fail to produce an adequate response, 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.

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Article Sources

  1. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-74. doi:10.1002/acr.21596

  2. Al-saeed A. Gastrointestinal and Cardiovascular Risk of Nonsteroidal Anti-inflammatory Drugs. Oman Med J. 2011;26(6):385-91. doi:10.5001/omj.2011.101

  3. Mcalindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363-88. doi:10.1016/j.joca.2014.01.003

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