Treatments for osteoarthritis
Osteoarthritis (OA) is caused by cartilage degradation. This leads to symptoms like:
The best OA treatment will depend on your symptoms. It will also depend on your needs and the severity of your OA at the time of diagnosis.
Most doctors begin OA treatment with simple, noninvasive options. “Noninvasive” means the treatment won’t involve inserting anything into the body
However, you may need more intensive treatment if your symptoms aren’t manageable with lifestyle changes and medication. For some people, surgery (an invasive treatment) can be the best way to manage the symptoms of severe OA.
Many people can help control their OA symptoms with basic lifestyle changes. Talk to your doctor about whether these options may be right for you.
Exercise can play a major role in reducing the pain that comes with OA. An active lifestyle can help you:
- maintain healthy joints
- relieve stiffness
- reduce pain and fatigue
- increase muscle and bone strength
- improve balance to prevent falls
People with OA should stick to gentle, low-impact exercise. It’s important to stop exercising if you begin to feel any new or increased joint pain. Any aches that last for more than a few hours after you finish exercising mean that you’ve probably done too much.
For example, you might consider aquatic exercise, which is considered ideal for people with OA. It’s less weight bearing, so it’s gentler on your joints. As well, exercising in warm water increases blood flow to your joints, which brings in nutrients and proteins essential for repairing damaged tissue.
When it comes to OA, exercise isn’t just about aerobic conditioning. You also need to work on strength and stretching to support your joints and to maintain your flexibility.
Maintaining a healthy weight can reduce stress on joints. If you are overweight or obese, talk to your doctor about how to lose weight safely. Weight loss can help with the pain of OA, especially for OA of the knee. It may also reduce inflammation in the body.
A healthy diet can also help you get essential nutrients that might decrease inflammation and may slow the progression of arthritis.
If your joints are swollen and achy, give them a break. Try to avoid using an inflamed joint for 12 to 24 hours to let the swelling go down. It’s also a good idea to get enough sleep. Fatigue may increase your perception of pain.
Cold and heat
Both cold and heat can help treat OA symptoms. Applying ice to an aching area for 20 minutes helps restrict blood vessels. This reduces fluid in the tissue and decreases swelling and pain. You can repeat the treatment two or three times a day.
A bag of frozen vegetables makes a great ice pack. Just make sure to wrap any ice pack you use in a T-shirt or towel. Otherwise, the cold could hurt or even damage your skin.
You can do the same 20-minute treatment pattern with a hot water bottle or a heating pad. Both can be found at your local drugstore. Heat opens the blood vessels and increases circulation, which as previously mentioned aids in repairing damaged tissue. Heat is also good for helping with stiffness.
You may find relief with both cold and heat. Experiment to see what works best for you. However, restrict your use to no more than 20 minutes at a time. Then give your body a break.
Several types of over-the-counter (OTC) medications may help relieve OA symptoms. However, different types of drugs have different effects. It’s important to choose the right drugs to help with your symptoms.
Acetaminophen (Tylenol) is an OTC painkiller. It reduces pain, but not inflammation. Taking too much can cause liver damage.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help combat multiple OA symptoms. As implied by their name, they reduce inflammation. They also help with pain. OTC NSAIDs include:
- aspirin (Bufferin)
- ibuprofen (Advil, Motrin, Nuprin)
- naproxen (Aleve, Naprosyn)
It’s important to note that NSAIDs can potentially cause significant side effects over time. These can include:
- stomach problems
- cardiovascular disease
- ringing in the ears
- liver damage
- kidney damage
- bleeding problems
Using a topical NSAID (one applied to your skin) may decrease risk of these side effects, as less of the medication circulates in the body.
A variety of creams and gels are available that can help relieve OA pain. These may contain active ingredients such as menthol (Bengay, Stopain) or capsaicin (Capzasin, Zostrix). Capsaicin is the substance that makes hot peppers “hot.”
Diclofenac, an NSAID, comes in a gel form (Voltaren gel) or solution (Pennsaid), which require a prescription.
For some people with OA, OTC painkillers aren’t helpful enough. You may need prescription medications if symptoms start to affect your quality of life. Managing the pain and swelling may help you perform normal, everyday tasks.
Corticosteroids reduce inflammation, which decreases swelling and pain in joints. For OA, corticosteroids are usually given by injection, so they should be administered only by an experienced clinician and used judiciously to avoid complications and side effects.
Corticosteroid injections may only be needed once for benefit. However, they may be given three or four times per year if needed.
Currently, triamcinolone acetonide (Zilretta) is the only FDA-approved corticosteroid to treat osteoarthritis of the knee. This brand-name drug is more expensive than generic triamcinolone acetonide, which is available for other forms of OA.
Prescription NSAIDs do the same thing as OTC NSAIDs. However, they are available in stronger doses that work for longer periods of time. Prescription NSAIDs include:
- celecoxib (Celebrex)
- piroxicam (Feldene)
- prescription-strength ibuprofen and naproxen
Prescription NSAIDs can sometimes cause undesirable side effects. Talk to your doctor about how to reduce your risk.
Strong painkillers can provide relief from severe pain, but it should be noted that they also have the potential to cause addiction, and aren’t recommended for treating OA. These include:
- meperidine (Demerol)
- oxycodone (OxyContin)
- propoxyphene (Darvon)
- tramadol (Ultram)
In addition to drugs and surgery, other medical treatments for OA are available. These treatments aim to restore proper function to your joints.
Physical therapy can be useful for some people with OA. It can help:
- improve muscle strength
- increase the range of motion of stiff joints
- reduce pain
- improve gait and balance
A physical therapist can help you develop an exercise regimen suited to your needs. Physical therapists can also help you with assistive devices such as:
These can provide support to weakened joints. They can also take pressure off injured bones and reduce pain.
In addition, a physical therapist can show how to use canes or walkers. They may also try taping parts of the knee, such as the patella, to ease knee pain for some people.
Severe cases of OA may require surgery to replace or repair damaged joints. There are several types of surgery and types of implants used in OA.
If surgery for OA is required, joint replacement is generally the best option. This is particularly true for people who are older, because they are unlikely to need a second replacement.
Joint replacement surgery is also known as arthroplasty. This procedure removes damaged joint surfaces from the body and replaces them with prosthetics made of plastic or metal. Hip and knee replacements are the most common types of joint replacement. However, other joints can be replaced, including the shoulders, elbows, fingers, and ankles.
Prosthetic joints may last two decades or more. However, the lifespan of a joint replacement depends on how that joint is used and how strong the supporting tissues are over time.
Osteotomy is a type of surgery used to realign bones damaged by arthritis. This relieves stress on the damaged part of the bone or joint. Osteotomy is usually performed only on younger people with OA, for whom joint replacement isn’t preferable.
The bones in a joint can be permanently fused to increase joint stability and reduce pain.
This surgery usually results in severely limited or no range of motion in the joint. However, in serious OA cases, it may be the best way to relieve chronic, debilitating pain.
Bone fusion is also known as arthrodesis.
In this procedure, a surgeon trims torn and damaged cartilage from a joint. This is done with the use of an arthroscope. An arthroscope is a small camera on the end of a tube. It allows doctors to see into the knee joint while performing procedures on the joint. Arthroscopy can also be used to remove bone spurs.
In the past, this was a popular surgery to treat osteoarthritis of the knee. However, research has shown that arthroscopy is no more effective at treating long-term pain than medication or physical therapy.
Many options are available for treating osteoarthritis. If you have OA, work with a doctor to find the right treatment for you.