The aches and pains that come with osteoarthritis (OA) can make work and life more difficult. When you have OA, the cartilage that pads the bones in your joints deteriorates. It’s common to have decreased mobility as a result. About 27 million Americans have OA, according to the Arthritis Foundation. Arthritis is the nation’s number one cause of disability, and OA is the most common kind.
It’s important for you to find the right approach to manage and treat your OA. OA is caused by wear and tear on your joints — typically your knees, hips, lower back, neck, or shoulders. It usually gets worse if it’s left untreated.
Dr. Nels Carlson, an associate professor in the Department of Orthopedics and Rehabilitation at Oregon Health Sciences University, suggests following this six-step approach:
Step 1: Verify that your condition is osteoarthritis.
Symptoms of OA include:
- joint swelling
- decreased range of motion in the joint
Many people with OA experience this pain first thing in the morning. It can often last for a few hours or more.
Visit an OA specialist for a physical exam (and maybe X-rays or an MRI) if you think you might have OA. Other conditions — including rheumatoid arthritis, immune system disorders, and injuries — can have similar symptoms.
Step 2: Attempt to control OA through weight loss, exercise, and self-treatment.
Dr. Carlson believes it’s best to start with a conservative treatment approach for most people with OA. “Lifestyle changes are key,” he says. Lifestyle changes that can help include:
- Losing weight. This reduces the stress on your joints, particularly in your knees. Aquatics and other low impact forms of exercise are ideal. You may require cold and hot compresses after exercise (or just as a way to manage inflammation).
- Wearing 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 people with OA find that over-the-counter medications like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce joint pain, stiffness, and swelling. Ibuprofen, naproxen, and aspirin are all NSAIDs. However, around-the-clock use of these medications can result in other problems. These include gastrointestinal distress and stomach ulcers, Dr. Carlson warns.
If these medications are ineffective or you have severe pain or can’t tolerate over-the-counter remedies, you doctor might prescribe opioids, such as codeine. Dietary supplements like glucosamine and chondroitin sulfate may also help. Studies are mixed about how effective these supplements are, but Carlson says there’s no harm in trying them.
Step 4: Consider injections.
Your doctor may suggest an injection of corticosteroids or hyaluronic acid if there’s little or no improvement from using a brace or taking over-the-counter medications. Corticosteroids don’t eliminate pain directly, but they can drastically reduce inflammation and swelling. However, cortisone injections could result in side effects like:
- temporary rise in blood sugar in people with diabetes
Long-term side effects can include:
- weight gain
- facial swelling
- 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 like stretching and strengthening that help alleviate the inflammation and pain associated with OA, Dr. Carlson notes. You could also visit an experienced message therapist who can focus on problem areas.
The remaining option is to submit to the scalpel if these treatments haven’t worked, or if your OA has advanced.
Step 6: Undergo surgery.
Those with advanced OA may require a resurfacing or realignment procedure of an ankle, knee, or hip replacement, Dr. Carlson points out. These procedures are usually effective, but there’s no guarantee they will eliminate the inflammation and pain. “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,” Dr. Carlson 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.” Your doctor might also 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.”