The persistent aches and pains associated with osteoarthritis can make it difficult to navigate work and life. As cartilage surrounding bone surfaces deteriorates, decreased mobility and movement result. According to The Arthritis Foundation, nearly 27 million Americans suffer from the disease. In fact, OA is the nation’s number one cause of disability.

If you have OA, it’s essential to adopt the right approach for managing and treating it. OA is caused by wear and tear on a joint—typically knees, hips, lower back, neck and shoulders—and, left untreated, it usually gets worse.

Nels Carlson, MD, assistant professor in the Department of Orthopedics and Rehabilitation at Oregon Health Sciences University, suggests taking the following six-step approach:

Step 1: Verify that your condition is osteoarthritis.

Symptoms of OA include joint swelling, stiffness and pain. Oftentimes, it also leads to decreased range of motion in the joint. Many OA sufferers experience this pain upon waking in the morning and it frequently lasts for a few hours or longer. If you think you might have OA but it hasn’t been diagnosed, visit an osteoarthritis specialist for a physical exam and possible X-Rays or an MRI. Other conditions—including rheumatoid arthritis, immune system disorders and injuries—occasionally produce similar symptoms.

Step 2: Attempt to control OA through weight loss, exercise and self-treatment.

Dr. Carlson believes that for most OA sufferers it’s best to start with a conservative treatment approach. “Lifestyle changes are key,” he says. Number one is losing weight, which reduces stress on the joints—particularly in the knees. Aquatics and other low impact forms of exercise are ideal. You may require cold and hot compresses after exercise (or simply as a way to manage inflammation). Another option is a splint, shoe insert or brace. “It can unload the arthritic component of an affected area,” Dr. Carlson notes. If you are still unable to control the inflammation and pain then you may need to take medication.

Step 3: Rely on medication as needed.

Many with OA find that over-the-counter medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) with ibuprofen, naproxen and aspirin help reduce joint pain, stiffness and swelling. However, around-the-clock use of these medications can result in other problems, including gastro-intestinal distress and ulcers, Dr. Carlson warns. If these medications are ineffective or a person is coping with severe pain or can’t tolerate over the counter remedies, doctors might prescribe opioids, including codeine. Dietary supplements such as glucosamine and chondroitin sulfate may also help. Studies are mixed about the efficacy of these supplements but Carlson says there’s no harm in trying them.

Step 4: Consider injections.

If there’s little or no improvement using a brace and/or OTC medications, a doctor will likely suggest Corticosteroids or hyaluronic acid derivatives through injection. The former can drastically reduce inflammation and swelling—though they do not eliminate pain directly. However, cortisone injections could result in soreness, sweating and insomnia. Diabetics might also experience a temporary rise in blood sugar. Longer-term side effects include weight gain, osteoporosis, facial swelling, cataracts and a rise in blood pressure. Hyaluronic acid—currently approved only for the knee—may help cushion the problem area.

Step 5: Consider physical therapy.

A physical therapist can provide treatments and exercises—including stretching and strengthening—that help alleviate the inflammation and pain associated with OA, Dr. Carlson notes. Another potential resource is an experienced message therapist who can focus on problem areas. If these options are ineffective or the disease has reached an advanced state, the remaining option is to submit to the scalpel.

Step 6: Undergo surgery.

Those with advanced osteoarthritis may require a resurfacing or realignment procedure or an ankle, knee or hip replacement, Dr. Carlson points out. Although these procedures are usually effective, there’s no guarantee they will eliminate the inflammation and pain. Moreover, “The recovery time can stretch into months. There is usually a lot of work with a physical therapist and it will not be pain free,” he explains. Postoperative rehab typically involves range of motion exercises and strengthening techniques. “The goal is to get a person back to his or her usual routine.” In addition, a doctor might prescribe pain medication, including opioids.

Talk to your doctor

Of course, there’s no one-size-fits all approach to managing and treating osteoarthritis. But Dr. Carlson emphasizes the need to keep weight down, keep muscles strong and improve range of motion.

“It’s important to discuss various options and treatments with your doctor and understand the pros and cons before making any decision,” he says. “You must be comfortable with the game plan and know that it is right for you.”