Osteoarthritis Treatments

More than 27 million people in the U.S. have osteoarthritis. Specifically, according to the Centers for Disease Control and Prevention (CDC), osteoarthritis affects 13.9 percent of adults aged 25 years and older and 33.6 percent of adults 65 and older. It is the most common type of arthritis. The knees, hands, feet, hips, and spine are the joints most commonly affected by osteoarthritis.

People with symptomatic osteoarthritis need effective treatment to control joint pain, stiffness, swelling, and other symptoms. Other goals of treatment include preserving or improving joint function, minimizing disability, and improving quality of life.

People with the disease are often confused by so many treatment options—and quite honestly, they would like to skip what doesn't work and focus on what does. There is not one solution for everyone, but researchers have produced guidelines for the treatment of osteoarthritis. There are non-pharmacologic (non-drug) treatment options for osteoarthritis, pharmacologic (drug) treatments, topical medications, intra-articular injections, lifestyle modifications—and as a last resort, surgery.

In 2012, the American College of Rheumatology (ACR), published pharmacologic and non-pharmacologic treatment recommendations for the hand, hip, and knee. The panel of clinical experts offered a strong recommendation, conditional recommendation, or no recommendation for specific treatment options. To be deemed a strong recommendation, high quality evidence was required, as well as evidence that greatly favored benefits versus any risks associated with treatment. A conditional recommendation was associated with a lack of sufficient high quality evidence or evidence that was less distinct when weighing benefits versus risks. If no recommendation was offered, there is inadequate data or no data from randomized, controlled clinical trials. 

Hand (Pharmacologic Treatment Options)

No strong recommendations were made by the experts associated with the ACR in this treatment category. The experts conditionally recommended the use of one or more of the following treatment options:

The expert panel conditionally recommended that the following NOT be used:

Also, it was conditionally recommended that people with osteoarthritis who are 75 years old or older should use topical NSAIDs rather than oral NSAIDs.

Hand (Non-Pharmacologic Treatment Options)

There was insufficient evidence available to make strong recommendations in this treatment category as well, but several conditional recommendations were made. The ACR conditionally recommends that health professionals (primary care provider, physical therapist, or occupational therapist) should:

Hip (Pharmacologic Treatment Options)

No strong recommendations were made for initial pharmacologic options to treat hip osteoarthritis. Conditional recommendations include use of one of the following medications for initial treatment:

Experts conditionally recommend that the following treatment options NOT be used for hip osteoarthritis:

No recommendation was made regarding the use of:

Hip (Non-Pharmacologic Treatment Options)

Experts strongly recommend that people with hip osteoarthritis:

Experts conditionally recommend that people with hip osteoarthritis:

  • participate in a self-management program
  • receive manual therapy (massage) combined with supervised exercise
  • receive psychosocial interventions
  • receive instruction regarding the use of thermal modalities
  • receive and use walking aids, as is necessary

Experts offered no recommendation with regard to the following treatment options:

  • balance exercise, alone or combined with strengthening exercises
  • tai chi
  • manual therapy alone

Knee (Pharmacologic Treatment Options)

No strong recommendations for the initial treatment of knee osteoarthritis were made. Experts conditionally recommend that one of the following be used:

  • acetaminophen
  • oral NSAIDs
  • topical NSAIDs
  • tramadol
  • intra-articular corticosteroid injections

Experts conditionally recommend that people with knee osteoarthritis NOT use:

  • chondroitin sulfate
  • glucosamine
  • topical capsaicin

No recommendation was made for the use of intra-articular hyaluronates, duloxetine, or opioid analgesic medications.

Knee (Non-Pharmacologic Treatment Options)

Experts strongly recommend the following non-pharmacologic treatment options for people with knee osteoarthritis:

  • participate in aerobic exercise or resistance land-based exercise, or both
  • participate in aquatic exercise
  • lose weight, if overweight

Experts conditionally recommend that people with knee osteoarthritis:

  • participate in a self-management program
  • receive manual therapy combined with supervised exercise
  • receive psychosocial interventions
  • use medially-directed patellar taping
  • wear medially wedged insoles (if diagnosis is lateral compartment osteoarthritis)
  • wear laterally wedged subtalar strapped insoles (if diagnosis is medial compartment osteoarthritis)
  • receive instruction regarding the use of thermal modalities
  • receive and use walking aids, if indicated
  • participate in a tai chi program

No recommendation was offered for:

  • balance exercise, alone or combined with strengthening exercise
  • wearing lateral wedged insoles
  • receiving manual therapy alone
  • wearing knee braces
  • using laterally-directed patellar taping

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:

Treatment of Other Joints

While the feet and spine, as well as other joints, were not included in the treatment recommendations from the  American College of Rheumatology, 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 weightbearing joints. If conservative treatment options fail to produce an adequate response, surgery may be considered as a last resort. 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.

A Word From Verywell

The American College of Rheumatology recommendations for the treatment of hand, hip, and knee osteoarthritis 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.

Verywell has provided you with this reference document because it is easy to understand and will allow you to discuss your initial treatment options with your doctor. If your response is inadequate, you can also easily see your other options. And, for specific treatments, there are links to more extensive information.

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