How is Osteoarthritis treated?

At present, there is no proven treatment that can reverse the damage of OA in the joints. Researchers are trying to find ways to slow or reverse this joint damage. The goal of treatment is to reduce pain and improve function of the affected joints. OA is a chronic condition that gradually worsens over time. However, arthritis treatment can often reduce your symptoms, can allow you to stay active, and can possibly slow the progression of this condition. Treatment includes a combination of non-pharmacologic therapies (therapies other than drug therapy), drug therapy, and, in some cases, surgery.

Physical measures—Weight loss and exercise are useful in OA. Excess weight puts stress especially on your knee joints, hips and low back. For every 10 pounds of weight you lose over 10 years, you can reduce the chance of developing knee OA by up to 50%. In addition, exercise can improve your muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA. Arthritis symptoms are typically worsened by activity and are improved with rest. However, a complete lack of activity can lead to a loss of muscle and joint stiffness.

If arthritis flares and causes significant pain and inflammation, your healthcare provider may recommend rest for 12 to 24 hours, followed by a return to usual activities.

The use of support (“assistive”) devices is also helpful, such as braces or a walking cane that can help you do daily activities. Heat or cold therapy can help relieve OA symptoms for a short time.
Certain alternative treatments such as spa (hot tub), massage, acupuncture and chiropractic manipulation can help relieve pain for a short time. They can be costly, though, and require repeated treatments. Also, the long-term benefits of these alternative (sometimes called complementary or integrative) medicine treatments are unproven but are under study.

Heat and cold therapies—Applying heat and cold to arthritic joints can help to control arthritis symptoms such as pain and stiffness.

  • Heat therapy—Heat relieves pain and stiffness in arthritic joints. Heat can be applied to the joints with hot packs, hot water bottles, heating pads, or electrically heated mittens.

It is important to avoid burning the skin with heat therapy. To avoid burns, hot water bottles should be filled with warm, not boiling, water. Heating pads should be set on a timer and used for no more than 20 minutes at a time. The heating pad can be reapplied after 20 minutes of no use.

  • Cold therapy—Cold relieves pain in arthritic joints and reduces muscle spasms. Cold can be applied for short periods using ice packs or coolant sprays. People with certain medical conditions, such as the Raynaud phenomenon, should not use cold therapy.

Drug Therapy—Forms of drug therapy include topical, oral (by mouth) and injections (shots). You apply topical drugs directly on the skin over the affected joints. These medicines include capsaicin cream, lidocaine and diclofenac gel. Oral pain relievers such as acetaminophen are common first treatments. So are nonsteroidal anti-inflammatory drugs (often called NSAIDs), which decrease swelling and pain.

In 2010, the government (FDA) approved the use of duloxetine (Cymbalta) for chronic (long-term) musculoskeletal pain including from OA. This oral drug is not new. It also is in use for other health concerns, such as mood disorders, nerve pain and fibromyalgia. Patients with more serious pain may need stronger medications, such as prescription narcotics.

Joint injections with corticosteroids (sometimes called cortisone shots) or with a form of lubricant called hyaluronic acid can give months of pain relief from OA. This lubricant is given in the knee, and these shots may help delay the need for a knee replacement by a few years in some patients.

Surgery—Surgical treatment becomes an option for severe cases. This includes when the joint has serious damage, or when medical treatment fails to relieve pain and the patient has significant loss of function. Surgery may involve arthroscopy, repair of the joint done through small incisions (cuts). If the joint damage cannot be repaired, a joint replacement is needed.

Supplements—Many over-the-counter nutrition supplements have been used for treatment of OA. Most lack good research data to support their effectiveness and safety. Among the most widely used are glucosamine/chondroitin sulfate, calcium and vitamin D, and omega-3 fatty acids. To ensure safety and avoid drug interactions, it is important to consult your doctor or pharmacist before using any of these supplements. This is especially true when combining these supplements with prescribed drugs.

Living with Osteoarthritis

There is no cure for OA, but you can manage how it affects your lifestyle. Some important tips include:

  • Properly position and support your neck and back while sitting or sleeping.
  • Adjust furniture, such as raising a chair or toilet seat.
  • Avoid repeated motions of the joint, especially frequent bending.
  • Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA.
  • Exercise each day.
  • Use arthritis support devices that will help you do daily activities.
  • You might want to work with a physical therapist or occupational therapist to learn the best exercises and to choose arthritis assistive devices.

Arthritis education and support – Arthritis symptoms may cause you to feel frustrated, dependent upon others for help, and even depressed. These factors may reduce your motivation to stick with arthritis treatment. By learning more about osteoarthritis, you can better participate in your own care. It is important to discuss the options for the treatment of arthritis, the effects of arthritis on daily activities, and the strategies for coping with the limitations imposed by arthritis with your healthcare provider.