Osteoarthritis

Treatment options

It is important that you get your osteoarthritis (OA) diagnosed and treated as early as possible. Early diagnosis and treatment is the first step in successful management of osteoarthritis. Your doctor may start you on a drug therapy regime, but ultimately you are the key factor in living successfully with OA. In addition to, and maybe more important than, medications you may take, making healthy lifestyle changes, managing stress and depression, avoiding joint damage, and balancing rest and activity will play a key role in battling the pain and limitations that can come with OA.

The goals of any treatment plan for OA include:

• Controlling pain and other symptoms

• Improving your ability to function in daily activities

• Slow the disease’s progress

Most treatment plans will include a combination of the following elements:

• Exercise

• Weight control

• Joint protection

• Physical and occupational therapy

• Medications

In severe cases, when the therapies above don’t work, surgery may be considered.

Medications

Most people with osteoarthritis will use drug therapy to ease the symptoms of the disease. Most drugs focus mainly on relieving pain, but some are targeted at other symptoms and slowing disease progression. You and your doctor should work together to find the combination of medications that works best for you. Following are examples of medications your doctor might consider.

Analgesics - Analgesics relieve pain without relieving inflammation or swelling. If you are only interested in pain relief, these drugs tend to have fewer side effects. They are recommended for people with mild-to-moderate pain. Examples of analgesics include acetaminophen, propoxyphene hydrochloride, and tramadol.

Topical Analgesics - Topical analgesics include creams or rubs that are applied directly over the painful area. These are available over-the-counter and often can be used in combination with oral medications to relieve pain. Never use topical analgesics with heat treatments; the combination can cause serious burns. Active ingredients include counterirritants (wintergreen oil, camphor, eucalyptus), which stimulate nerve endings to distract the brain from joint pain; salicylates, which hamper the activity of prostaglandins, which are chemicals in the body involved in pain and inflammation; and capsaicin, which uses the natural ingredient found in cayenne peppers to relieve pain by depleting a neurotransmitter that sends pain messages to the brain.

Nonsteroidal anit-inflammatory drugs (NSAIDs) - NSAIDs reduce inflammation and swelling as well as aid in pain relief and are recommended for people who have moderate-to-severe pain and signs of inflammation associated with OA. Examples of NSAIDs include aspirin, ibuprofen, ketoprofen, naproxen, naproxen sodium and meloxicam.

Cox-2 Drugs - Cox-2 drugs are targeted NSAIDs that don’t cause the stomach irritation associated with traditional NSAIDs. Examples of cox-2 drugs are celecoxib and valdecoxib.

Injectable glucocorticoids - Injectable glucocorticoids are steroids that are injected into the joint for fast, targeted pain relief. They are recommended as an alternative initial therapy for people with moderate-to-severe knee pain and signs of inflammation who do not get relief from acetaminophen. You may only have these injections in the same joint three or four times a year.

Viscosupplements - Viscosupplementation is used specifically for knee osteoarthritis and must be administered by an orthopaedic surgeon. It involves a series of injections over a period of weeks into the joint of hylauronic acid, a substance found in the body that gives joint fluid its viscosity. Examples are Synvisc and Hyalgan.

Learn more about arthritis medications. 

Physical and Occupational Therapy

Your osteoarthritis (OA) may be treated by your primary care physician or you may be referred to a rheumatologist (an arthritis specialist) or an orthropaedic surgeon.

Sometimes OA can affect your ability to do everyday tasks such as bathing, dressing and walking. If you are having trouble with these types of tasks, your doctor may prescribe physical or occupational therapy. A physical or occupational therapist can give you more good recommendations on protecting your joints. Ask your doctor to refer you to one if you feel you need additional assistance.

Physical therapy works on strengthening your muscles and improvng your flexibility and your joint mobility. Your physical therapist will work with you on a specific exercise program and other pain management techniques.

Occupational therapy focuses on helping you manage your daily activities. Your occupational therapist will show you ways to perform tasks without putting damaging stress on your joints. They also may show you how to use splints and braces to stabilize your joints and reduce pain. They also know which products can help you complete tasks more comfortably. 

Surgery

While most people with osteoarthritis won’t need surgery, it might be an option for you if you experience severe joint damage, extreme pain or very limited motion as a result of your OA. The benefits of surgery include improved movement, pain relief and improve joint alignment. Of course, there are always risks to surgery, especially if you have other health problems or you are overweight, which can add stress to the heart and lungs during surgery. There also is the risk of forming blood clots in your legs. You can help prevent this by taking blood-thinning medications and doing leg exercises to increase circulation before surgery.

There are several different types of joint surgery. Below are the ones most commonly done on people with osteoarthritis.

Arthroscopic Surgery - In this procedure, the surgeon inserts a very thin tube with a light at the end into the joint through a small incision. It is connected to a closed-circuit television and allows the surgeon to see the extent of the damage in the joint. Once there, the doctor can take tissue samples, remove loose cartilage, repair tears, smooth a rough surface or remove diseased synovial tissue. It is most commonly performed on the knee and shoulder.

Osteotomy - Literally meaning, “to cut bone,” this procedure is used to increase stability by redistributing the weight on the joint. Osteotomy is useful in people with unilateral hip or knee osteoarthritis (involvement in only one joint), who are too young for a total joint replacement.

Joint Replacement Surgery or Arthroplasty - This is the surgical reconstruction or replacement of a joint. Successfully used to help people who otherwise might be in a wheelchair, joint replacement surgery involves the removal of the joint, resurfacing and relining of the ends of bones and replacing the joint with a man-made component. This procedure is usually recommended for people over 50 or who have severe disease progression. Typically a new joint will last between 20 and 30 years.

For more complete information about joint surgery, visit the Joint Surgery Center.

Bracing

Bracing is a treatment option mostly used in combination with other solutions. Bracing can help stabilize your affect joint, allowing it time to heal after surgery or redistributing weight and limiting motion so you can better function in your daily life. Learn more about bracing and arthritis.

Alternatives

Osteoarthritis (OA) may respond to some alternative or complementary therapies. Following are some that are commonly used with osteoarthritis.

Glucosamine and Chondroitin Sulfate. Glucosamine is an amino sugar that appears to play a role in the formation and repair of cartilage. Chondroitin sulfate is part of a protein that gives cartilage elasticity. These two dietary supplements have been used for years to treat osteoarthritis in dogs and horses and in Europe to treat osteoarthritis in people. Studies show that people with mild-to-moderate OA who took these supplements reported pain relief similar to those achieved with NSAIDs, although the supplements may take longer to begin working. Common side effects include increased intestinal gas and softened stools. Other cautions include:

• Women who are pregnant or who may become pregnant should not take glucosamine and chondroitin sulfate because the effects on unborn children have not been studied.
• If you have diabetes, get your blood sugar levels checked frequently because glucosamine is an amino sugar.
• If you take blood-thinning medications or daily aspirin therapy, have your blood clotting checked more frequently. Chondroitin sulfate is similar in structure to the blood thinner heparin, and the combination may cause bleeding in some people.
• If you are allergic to shellfish, consult your doctor before taking glucosamine because it is extracted from crab, lobster or shrimp shells. In most cases, however, the allergies are triggered by the proteins in shellfish, and glucosamine is extracted from a carbohydrate called chitin.
• Don’t give up your other medications without talking to your doctor.
• Try the supplements along with your regular medications for six to eight weeks. If you don’t experience any change in your symptoms, then they probably won’t work for you.

Vitamins. Some research has shown that antioxidants in certain vitamins may help ease certain symptoms of osteoarthritis. In general, vitamins from whole foods are believed to be better absorbed by the body than supplements. Vitamin C has been shown to counteract the wearing away of cartilage in animals with OA. In humans, it is associated with decreased OA progression and pain. Vitamin E provides some pain relief to people with OA, however one study showed it was not as affective in easing OA pain in African-American men. Vitamin D may have preventative qualities when it comes to OA. One study found that disease progression was faster in people who had a low intake of the vitamin.

Chiropractic. Chiropractic care involves the manipulation and manual adjustment of the spine. Manipulation of some joints may help relieve osteoarthritis pain, but joint manipulation of weak or damaged joints could cause problems. Be sure to tell your chiropractor that your have osteoarthritis and select one that has experience working with people with arthritis.

For additional information on supplements for osteoarthritis, visit the Supplement Guide. For more information about alternative and complementary treatments for arthritis, visit the Alternative Therapies section.

Self-Management Techniques

Nondrug therapies are an important part of the treatment of osteoarthritis. Like your medication therapy, you will need to work with your healthcare team to develop a plan that works for you. Following are several elements you will need to consider when creating your plan.

Exercise
Exercise is the most effective nondrug treatment for reducing pain and improving movement in osteoarthritis. Don’t worry that you might do more damage to your joints by exercising them. Research has shown that people with osteoarthritis can exercise safely. In fact, moderate physical activity on a regular basis help decrease fatigue, strengthen muscles and bones, increase flexibility and stamina, and improve your general sense of well-being. Joint flexibility is especially important when you have OA because stiff joints means inability to do daily tasks, such as buttoning a shirt or starting the car. Learn more about three exercises you should do and watch a video for step-by-step instructions.

Weight Control
Weight control is particularly important for people with OA. Excess weight directly contributes to the development of osteoarthritis. Weight control not only helps prevent OA, it is an important element in your treatment of the disease as well.

Maintaining your recommended weight or losing weight if you are overweight can lessen your pain by reducing stress on your affected joints. Weight loss specifically helps ease pressure on weight-bearing joints such as the hips, knees, back and feet.

If you are overweight, work with your doctor to devise a weight-loss plan that includes eating fewer calories and increasing physical exercise. Make sure you are getting enough nutrients to keep your body healthy and that the activities you choose don’t harm your joints. See the Exercise and Arthritis and Diet and Nutrition sections for more information.

Avoiding Joint Pain and Damage
You can take steps to protect your joints and manage joint pain and damage before it is severe. Doing this is as easy as reducing daily stresses and listening to your body.

Listening to your body is the most important thing you can do to take care of yourself. This is where balancing rest and activity really comes into play, because if you plan rest breaks in your day, you may avoid times of acute pain.

Both work and leisure activities are important. The trick is in balancing them. Moderations should be your motto, especially when your arthritis is more active.

Pace yourself. Take short breaks and alternate heavy and light activities during the day.

Don’t set unrealistic goals. Take some time to plan out your daily activities. Make a “to do” list that leaves you plenty of time to achieve all your tasks - and don’t add to it.

Keep active. Too much rest isn’t good for your joints either. Even on days when you are tired and stiff, try to do some exercise. By increasing your level of fitness, you will actually have more energy and less pain.

Know when to take breaks. Don’t wait for the physical signals of pain before you rest. Take a 15-minute break each hour to give your body a break from the computer, from standing or sitting too long or from concentrating to long on one task.

Use good body mechanics. Use your palms instead of your fingers when lifting or carry things. Use your larger muscles, rather than smaller ones, to carry things. For example, carry a backpack instead of a purse. Lift with your legs instead of your back. Use good posture, which takes stress off your joints.

Use assistive device when you need them. Devices that help you open jars, reach for items, sit down and get up from a chair or toilet seat, can help you manage your day and pain. Don’t hesitate to use them if you need to.

Work to organize and simplify your life. Rotate cleaning and don’t do it all in one day. Keep tools that help you out close by so you don’t have to search for them when you need them. Plan ahead for cooking and errand running so you minimize extra trips and rushing around for something you forgot.

Don’t forget that regular exercise will also help by making your muscles and joints stronger.