Guidelines for Osteoarthritis Treatments
Learn more about guidelines for treating hip and knee OA from the American College of Rheumatology.
The Importance of Exercise in Treatment
Based on their findings, the ACR issued a range of drug and non-drug recommendations. Two of the strongest are for land-based exercise and for weight loss when needed. “People with OA exercise less than the general population, yet exercise is critical for strength, flexibility and balance. There is good data showing that pain is reduced, functioning increased and surgery delayed with an exercise program,” says Sharon Kolasinski, MD, professor of medicine at Cooper Medical School in Camden, N.J., who was not involved in drafting the recommendations. “No intervention can halt the progression of OA, but exercise and weight loss are particularly important [for quality of life].”
Similarly, OA treatment guidelines by the European League Against Rheumatism (EULAR) and the American Academy of Orthopaedic Surgeons stress the importance of exercise and weight loss as a first line of OA treatment.
Other OA Treatment Guidelines
- Traditional pain relievers such as acetaminophen and oral non-steroidal anti-inflammatory drugs (NSAIDs).
- The synthetic opioid tramadol and corticosteroid joint injections.
- Topical rather than oral NSAIDs for people over 75, who are at higher risk from developing complications from oral NSAIDs.
- COX-2 inhibitor celecoxib (Celebrex) or a traditional NSAID along with a stomach-protective drug, such as esomeprazole (Nexium) or omeprazole (Prilosec) for younger people at high risk of gastrointestinal side effects.
- Opioids such as hydrocodone for people who don’t respond to other treatments and aren’t candidates for joint replacement. the panel cautioned that doctors who prescribe them should follow guidelines established by the American Pain Society and the American Academy of Pain Medicine.
- Tai chi, acupuncture, transcutaneous electrical nerve stimulation (TENS) or intra-articular hyaluronate injections for knee OA, but not hip OA.
Recommendations for Treatment for Hand OA
- A physician assessment of the patient’s ability to perform daily tasks.
- Use of assistive devices as needed.
- Splints for thumb OA.
- Oral or topical NSAIDs.
- Topical rather than oral for patients older than 75.
- Tramadol and capsaicin, a topical pain reliever derived from chili peppers.
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