Your Osteoarthritis Treatment Options

Everything changes over time, including your joints. Moving around -- running, jumping, kneeling, climbing stairs, and all your other activities -- is great for your body. But over time, you wear down your cushioning cartilage leaving bone rubbing painfully against bone. When joint cartilage erodes, joints become stiff, swollen, painful, and arthritic.

There are many types of arthritis, and osteoarthritis -- the “wear and tear” kind -- is by far the most common.. It becomes more common with age, and it can also occur if you are overweight.

Osteoarthritis can be treated. Medications and lifestyle changes won't cure your joint problems, but they can relieve your pain and help your knees, wrists, hips, and shoulders move better.

 

Simple Ways to Protect Your Joints

Two of the best things you can do for your joints don’t need a prescription.

Your weight could have a big effect on how you feel. Losing extra pounds takes pressure off your joints. Although there is no single “osteoarthritis diet,” it’s good for your whole body to favor lean protein, vegetables, fruits, whole grains, and healthier fats.

You’ll also want to get regular exercise. It strengthens the muscles around your joints, and there are plenty of choices (like swimming, biking, yoga, or hiking) that are easy on your body. 

Talk to your doctor about what’s OK for you to do and whether physical therapy would help.

Easy Home Remedies: A heating pad or cold pack can feel really good on achy joints. Use whichever one feels better unless you have an injury, in which case cold is best for the first couple of days.

You can apply cold or heat several times a day. Just remember to cover the cold pack with a towel and keep your heating pad at a low setting to avoid burning your skin. Whether you use heat or cold, remove it after 20 to 30 minutes.

Medications

Pain Relievers

Most people who are looking for osteoarthritis pain relief first turn to a group of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). Some of these drugs, including ibuprofen, naproxen and aspirin, are available over the counter. Stronger NSAIDs need a prescription.

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Be careful when you use NSAIDs because they can have side effects such as stomach bleeding and an increased risk for strokes, heart attack and other cardiovascular problems. Read the package label and talk to your doctor to make sure you use the lowest effective dose for the shortest period of time.

Even though NSAIDs are the most popular form of osteoarthritis pain relief, treatment guidelines actually recommend starting with acetaminophen because it doesn't come with the heart attack and stomach bleeding risks of NSAIDs, and it's good for easing arthritis pain.

Because acetaminophen can harm the liver and kidneys at high doses, make sure to stick with the recommended dosage and talk to your doctor if you need longer-term pain relief. Some people, such as those with existing liver disease or heavy drinkers, may not be able to take acetaminophen.

You may also want to try creams or gels that you rub on your affected joints. They include:

  • Capsaicin, the ingredient that gives hot peppers their kick, is also good for relieving osteoarthritis pain. It works by affecting the release of substance P, which is involved in transmitting the sensation of pain.
  • NSAIDs also come in lotions or creams, some of which are only available by prescription. If you use the NSAID diclofenac, your doctor will need to check your liver function 4 to 8 weeks after you start treatment, due to possible side effects.
  • Some products use ingredients like camphor, menthol, and eucalyptus to help with pain.

If you've already tried a variety of pain relievers and your joints still hurt or you can't tolerate NSAIDs or acetaminophen, your doctor may recommend a stronger opioid pain reliever like codeine, oxycodone, hydrocodone, tramadol, or one of these drugs combined with acetaminophen. Narcotic medications can become habit-forming and cause constipation and sedation, so it's important that you keep in close touch with your doctor while taking them.

Joint injections

Steroid shots, like cortisone, into the knee joint offer fast relief from joint pain and inflammation, and their effects can last for a few weeks to months.

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Hyaluronic Acid

Your joints contain a natural lubricant and shock absorber called hyaluronic acid, but people with osteoarthritis have less of this substance than normal. Hyaluronic acid is injected in the knee joint using products which may ease osteoarthritis pain in the knees, shoulders, and hips. This treatment may also help your joints move more smoothly. Side effects are usually mild and may include pain or swelling at the injection site.

Antidepressants

Your doctor may recommend the use of antidepressants to help treat chronic pain whether you have depression or not. The antidepressant duloxetine (Cymbalta) is approved for chronic musculoskeletal pain, including the pain of osteoarthritis.

Another class of antidepressants called tricyclics may also help manage chronic pain. These include, desipramine, imipramine  and nortriptyline. It is not exactly clear how antidepressants help curb pain, but antidepressant effects on brain chemicals is believed to play a role.

Side effects can range from drowsiness to dry mouth and blurred vision. Rarely, these drugs can lead to mood changes or suicidal thoughts.

Surgery

Most people with osteoarthritis don't need surgery. But if your pain and stiffness are so severe that you can’t get around, your doctor might suggest it as a last resort.

Surgery can improve your joint alignment, help your joints move more smoothly, and relieve your pain. Techniques used for osteoarthritis include:

Arthroscopy

During this procedure, the surgeon makes a very small cut in the affected joint and inserts a thin, lighted tube and small surgical instruments. Through this small cut, the doctor can view joint damage and remove loose pieces of cartilage, smooth out rough surfaces, or remove damaged tissues. It may temporarily ease arthritis pain, but there is debate about whether it works better than medication or physical therapy.

Osteotomy

If you're still young and active and have knee or hip osteoarthritis, you may be able to have an osteotomy, or joint-preserving surgery. By cutting and removing a section of the bone, this procedure improves joint alignment and stability so you can delay having joint replacement surgery.

Joint fusion

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In this operation, the surgeon removes the joint completely from the ends of the two bones that connect it. The bones are then held together with screws, pins, or plates until they heal. Over time, the bones should fuse into one piece, but the joint will no longer be flexible.

Joint Replacement (Arthroplasty)

Some people eventually need to replace a worn-out hip or knee joint with a plastic or metal version. If you only have osteoarthritis in one part of your joint, you may be able to have a partial knee or hip replacement instead of totally replacing that joint.

Alternative Remedies for Osteoarthritis

A few complementary and alternative treatments have been studied for osteoarthritis relief. But before you try them, it’s best to talk to your doctor so you know about any possible side effects or interactions with other treatments you're using.

Acupuncture is a popular arthritis treatment, and research shows it may help. But that’s not a given for everyone.

The dietary supplements glucosamine and chondroitin, used on their own or together, have also been touted for osteoarthritis relief. Studies have had mixed results. The research shows that people with mild osteoarthritis are the most likely to benefit. 

Helpful Devices

Braces, shoe inserts, and walking aids can help you get around more easily and take some of the stress off your joints.

Wearing a brace around your knee redistributes weight and takes some of the pressure off the joint. Braces are especially helpful when used along with treatments like medication and physical therapy. You can use a splint or soft sleeve to support sore wrist joints.

Placing an orthotic device called a wedge inside your shoe can help correct imbalances of the knee.

Using a cane to help you walk can take some of the weight off a painful hip or knee. It might even slow the damage from knee osteoarthritis.

Ask a Pro

Get help from your doctor, an occupational therapist,  a physical therapist, or all three to work on feeling better and moving more like you used to, ASAP.

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Your doctor is your main arthritis advocate. Keep in regular contact with your doctor to make sure your medication is working for you and that you are taking advantage of every possible treatment option.

An occupational therapist can help you make everyday tasks easier. This may include modifying your home to make it easier to get around and recommending gadgets to help you open jars, tie shoelaces, or handle other things.

A physical therapist can teach you exercises to improve the flexibility in your joints and show you how to use walking aids such as a cane, brace, or special shoe inserts.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on September 28, 2015

Sources

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CDC: "Arthritis -- Data and Statistics." 

Reijman, M. Annals of the Rheumatic Diseases, February 2007. 

Arthritis Foundation: "When are Braces Used for OA?" 

Kemp, G. Arthritis and Rheumatism, May 2008. 

Manheimer, E. Cochrane Database of Systematic Reviews, January 2010. 

Firestein, G. Kelley's Textbook of Rheumatology, 8th ed, W.B. Saunders, 2008.

Flood, J. The American Journal of Managed Care, March 2010. 

Hunter, D. Rheumatic Diseases Clinics of North America, August 2008.

Arthritis Foundation: "Osteoarthritis;" "Cardiovascular Risk and NSAID Use;" and "Types of Exercise."

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Kirkley, A. New England Journal of Medicine, September 2008. 

Calder, P. American Journal of Clinical Nutrition, June 2006.

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The University of Chicago: "Treatment and Therapy - Pain Medication." 

 

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