Treatments for Osteoarthritis


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Treatment list for Osteoarthritis: The list of treatments mentioned in various sources for Osteoarthritis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Treatment of Osteoarthritis: medical news summaries: The following medical news items are relevant to treatment of Osteoarthritis:

Treatments of Osteoarthritis discussion: Sometimes you might still have pain after using your medicine. Here are some things to try:

  • Take a warm shower.

  • Do some gentle stretching exercises.

  • Use an ice pack on the sore area.

  • Rest the sore joint.

If you still hurt after using your medicine correctly and doing one or more of these things, call your doctor. Another kind of medicine might work better for you. Some people can also benefit from surgery, such as joint replacement. 1

Despite these challenges, most people with osteoarthritis can lead active and productive lives. They succeed by using osteoarthritis treatment strategies such as

  • Pain relief medications

  • Rest and exercise

  • Patient education and support programs

  • Learning self-care and having a "good-health attitude."

2

Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle, and health. Osteoarthritis treatment has four general goals:

  • Control pain through drugs and other measures.

  • Improve joint care through rest and exercise.

  • Maintain an acceptable body weight.

  • Achieve a healthy lifestyle.

Osteoarthritis treatment plans often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery, and nontraditional treatment approaches.

Exercise: Research shows that one of the best treatments for osteoarthritis is exercise. This activity can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. (See Be a Winner! Practice Self-Care and Keep a Good-Health Attitude.)

Rest and Joint Care: Treatment plans include regularly scheduled rest. Patients must learn to recognize the body's signals, and know when to stop or slow down. This prevents pain caused by overexercising. Some patients find that relaxation techniques, stress reduction, and biofeedback help. Some use canes and splints to protect joints and take pressure off them. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints must be used for limited periods because joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help the patient get a properly fitting splint. 2

Pain Relief: People with osteoarthritis may have nonmedical ways to relieve pain. Patients can use warm towels, hot packs, or a warm bath or shower to apply moist heat to the joint. This can relieve pain and stiffness. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel) can relieve pain or numb the sore area. (Check with a doctor or physical therapist to find out if heat or cold is the best treatment.) Water therapy in a heated pool or whirlpool may also relieve pain and stiffness. For osteoarthritis in the knee, patients may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

Weight Control: Osteoarthritis patients who are overweight or obese need to lose weight. Weight loss can reduce stress on weight-bearing joints and limit further injury. A dietician can help patients develop healthy eating habits. A healthy diet and regular exercise help reduce weight.

Medicines: Doctors use medicines to eliminate or reduce pain and to improve functioning. Doctors consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and potential drug side effects. Patients must use medicines carefully and tell doctors about any changes that occur.

The following types of medicines are commonly used in treating osteoarthritis:

  • NSAIDs (Nonsteroidal anti-inflammatory drugs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some over the counter (for example, aspirin, Advil®*, Motrin® IB, Aleve®, ketoprofen). Others need a prescription. These drugs work in a similar way: they fight inflammation or swelling and relieve pain. However, each NSAID is a different chemical, and has slightly different effects in the body.

    * Note: Brand names included in this booklet are provided as examples only. Their inclusion does not mean they are endorsed by the National Institutes of Health or any other Government agency. Also, if a certain brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

    Side effects. NSAIDs can cause stomach irritation or affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, and the more serious those effects can be. Many other drugs cannot be taken with NSAIDs, because NSAIDs alter the way the body uses or gets rid of these drugs. NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding.

    COX-2 inhibitors. Two new NSAIDs, Celebrex® and Vioxx®, from a class of drugs known as COX-2 inhibitors, are now being used against osteoarthritis. These medicines reduce inflammation like traditional NSAIDs, but cause fewer gastrointestinal side effects.

  • Acetaminophen. A non-anti-inflammatory pain reliever (for example, Tylenol®). This drug does not irritate the stomach and is less likely than NSAIDs to cause long-term side effects. Research has shown that in many patients with osteoarthritis, acetaminophen relieves pain as effectively as NSAIDs.

    Warning: Patients with liver disease, heavy alcohol drinkers, and those on blood-thinning medicines should use acetaminophen with caution.

  • Other Medicines. Doctors may prescribe several other medicines for osteoarthritis. They include

    Topical pain-relieving creams, rubs, and sprays (for example, capsaicin cream) applied directly to the skin.

    Mild narcotic painkillers, which--while very effective--are addictive and rarely used.

    Corticosteroids, powerful anti-inflammatory hormones made naturally in the body or man made for use as drugs. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a short-term measure, not recommended for more than two or three times per year.

    Hyaluronic acid, a new medicine for joint injection, used to treat osteoarthritis of the knee. This substance is a normal component of the joint, involved in joint lubrication and nutrition. Many patients experience pain relief after a series of three to five injections.

2

Treatment Approaches to Osteoarthritis

  • Exercise

  • Medicines

  • Rest and joint care

  • Surgery

  • Pain relief techniques

  • Alternative therapies

  • Weight control

 

2

Surgery: For some people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to

  • Resurface (smooth out) bones.

  • Reposition bones.

  • Replace joints. Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material, and can be joined to bone surfaces by special cements. Artificial joints can last from 10 to 15 years or more. About 10 percent may need revision. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level, and other medical conditions.

  • Remove loose pieces of bone or cartilage from the joint to improve joint function.

2

The decision to use surgery depends on several things. Both surgeon and patient consider the patient's level of disability, intensity of pain, interference with lifestyle, age, and occupation. Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.

Nontraditional Approaches: Among the alternative therapies for treating osteoarthritis are

  • Acupuncture. Some people have found pain relief using acupuncture (the use of fine needles inserted at specific points on the skin). Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some patients. (See the Current Research section.)

  • Folk Remedies. Some patients seek alternative therapies for their pain and disability. Some of these alternative therapies have included wearing copper bracelets, drinking herbal teas, and taking mud baths. While these practices are not harmful, some can be expensive. They also cause delays in seeking medical treatment. To date, no scientific research shows these approaches to be helpful in treating osteoarthritis.

2

Most often osteoarthritis of the knee is treated with pain-reducing medicines, such as aspirin or acetaminophen (Tylenol*); nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Nuprin, Advil); and exercises to restore joint movement and strengthen the knee. Losing excess weight can also help people with osteoarthritis. 3

Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.

Medicines help relieve pain and reduce swelling. Acetaminophen or ACT should be the first drug used to control pain in patients with osteoarthritis . Patients with OA who don’t respond to ACT and patients with RA and gout are most commonly treated with nonsteroidal anti-inflammatory drugs such as ibuprofen. People taking medicine for any form of arthritis should limit the amount of alcohol they drink since these agents can irritate the stomach.

Exercise, such as a daily walk or swim, helps keep joints moving, reduces pain, and strengthens muscles around the joints. Rest is also important for the joints affected by arthritis. Physical therapists can develop personal programs that balance exercise and rest.

Many people find that soaking in a warm bath, swimming in a heated pool, or applying heat or cold to the area around the joint helps reduce pain. Controlling or losing weight can reduce the stress on joints and can help avoid further damage.

When damage to the joints becomes disabling or when other treatments fail to reduce pain, your doctor may suggest surgery. Surgeons can repair or replace damaged joints with artificial ones. The most common operations are hip and knee replacements. 4

In the past, doctors often advised arthritis patients to rest and avoid exercise. Rest remains important, especially during flares. But doing nothing results in weak muscles, stiff joints, reduced mobility, and lost vitality. Now, rheumatologists routinely advise a balance of physical activity and rest. Exercise offers physical and psychological benefits that include improved overall fitness and well-being, increased mobility, and better sleep.

Joints require motion to stay healthy. That's why doctors advise arthritis patients to do range-of-motion, or flexibility, exercises every day--even during flares. Painful or swollen joints should be moved gently, however.

Strengthening and endurance activities are also recommended, but should be limited or avoided during flares. Arthritis patients should consult their doctors before starting an exercise program, and begin gradually.4

Footnotes:
1. excerpt from Do I have Arthritis: NIAMS
2. excerpt from Handout on Health Osteoarthritis: NIAMS
3. excerpt from Questions and Answers About Knee Problems: NIAMS
4. excerpt from Arthritis: NWHIC
Last revision: June 4, 2003

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