How is osteoarthritis treated?
There is no cure for osteoarthritis. The symptoms usually are managed by a combination of several medical treatments, including medical management for moderate stages and surgery for advanced stages:
- Medications (topical pain medications and oral anti-inflammatories)
- Exercise (land- and water-based)
- Hot and cold packs (local modalities)
- Physical, occupational, and exercise therapy
- Weight loss (if overweight)
- Supportive devices such as crutches, canes, braces, and shoe inserts
- Intra-articular injection therapies (steroid, hyaluronic acid)
- Complementary and alternative medicine strategies
Surgery may be helpful to relieve pain when other medical treatments are ineffective or have been exhausted.
The goals of treatment are to:
- decrease joint pain and stiffness and delay further progression;
- improve mobility and function; and,
- increase patients' quality of life.
The type of treatment regimen prescribed depends on many factors, including the patient's age, overall health, activities, occupation, and severity of the condition.
Unlike other forms of arthritis where great advances have been made in recent years, progress has been much slower in osteoarthritis. Unfortunately, no medications are available today that have been shown to reverse or slow the progression of osteoarthritis.
Medications are focused on decreasing symptoms of the disease caused by osteoarthritis. Pain-relieving medications include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and stronger pain medications such as tramadol. Other topical medications in the form of analgesic patches, creams, rubs, or sprays may be applied over the skin of affected areas to relieve pain.
Although many of these medications are available in over-the-counter preparations, individuals with osteoarthritis should talk to a health care provider before taking the medications. Some medications may have dangerous or unwanted side effects and/or may interfere with other medications that are being taken.
Supportive or assistive devices help decrease stress on affected joints. Bracing and other supports may help to stabilize damaged joints. However, devices should be used sparingly and under the instruction of a health professional such as a therapist, physician, or other health care provider. Relying too much on some supports can lead to muscle wasting, which may make the problem worse. Shoe lifts or inserts and canes or crutches may be helpful to take pressure off certain joints and improve body and gait mechanics.
Exercise is important to improve flexibility, joint stability, and muscle strength. Regimens such as swimming, water aerobics, and low-impact strength training are recommended. These have been shown to decrease the amount of pain and disability that osteoarthritis sufferers have. Excessively vigorous exercise programs are best avoided, as they may increase arthritis symptoms and potentially hasten the progression of the disease. Physical therapists or occupational therapists can provide appropriate and tailored exercise regimens for individuals with osteoarthritis.
Hot and cold therapies
Hot and cold treatments may provide temporary relief of pain and stiffness. Such treatments include a hot shower or bath and the careful application of heating or cooling pads or packs.
Since obesity is a known risk factor for osteoarthritis, keeping your weight in check may help prevent osteoarthritis. Weight loss in overweight persons who have osteoarthritis has been shown to reduce stress and the amount of pain in weight-bearing joints.
When osteoarthritis pain cannot be controlled with medical management and it interferes with normal activities, surgery may be an option. Surgery is usually reserved for those people who have significant osteoarthritis. Several types of techniques can be employed, including minimally invasive joint replacement techniques. Although it has risks, joint surgery today can be very effective at restoring some function and reducing pain for appropriate individuals.
Alternative medicine nutraceuticals and supplements are compounds that are available without a prescription and are not licensed by the FDA as drugs. They include nutritional supplements, some vitamins, and other compounds sometimes referred to as "natural," "homeopathic," or "alternative" therapies. Many of these are no more or less "natural" than many prescription medications and may have side effects. It is important to emphasize that because the market for these compounds is less regulated, there is no guarantee that what is on the label is exactly what is in the bottle. Other modalities include acupuncture and stress management.
Glucosamine and chondroitin
Glucosamine and chondroitin are components of normal cartilage. They are most widely available as sulfate compounds. While some clinical trials (particularly in osteoarthritis of the knee) show they may have pain-relieving properties, others have not. Exactly how they work (if they do) remains unclear. There is no strong scientific evidence supporting the claim that they build bone and cartilage.
These nutritional supplements are available in pharmacies and health food stores without a prescription. As this market is less regulated than the food and drug market, many preparations exist and the actual quantity of ingredients may vary. At least initially, glucosamine and chondroitin appear to be safe and well-tolerated. Whether they have a true impact in the management of osteoarthritis remains to be seen and should be discussed with your physician before starting a trial of nutraceuticals.
Fish oils have some anti-inflammatory activity, but these oils have been studied more extensively for rheumatoid arthritis. Talk to your doctor before using any supplements or treatments.
Osteoarthritis symptoms can be managed. It is important to be accurately diagnosed, as there are many different causes of joint pain and joint stiffness. Please make an appointment with a rheumatologist about your joint pain.