Osteoarthritis, the wear-and-tear form of arthritis, affects one in two Americans during the course of their lifetime. Marked by pain, swelling, and reduced motion in the joints, OA typically strikes the hands, knees, hips or spine -- but any joint is at risk.
Does this mean you are a sitting duck? Not by a long shot. Although there are no drugs to alter the course of OA once the process is set in motion, many medications and therapies can help you feel better and stay active.
Managing Your Joint Pain
“The three most common OA culprits are excess weight, joint misalignment, or an injury such as a tear in one of the knee ligaments,” says Howard Hillstrom, PhD. He leads the Leon Root, MD, Motion Analysis Laboratory at the Hospital for Special Surgery in New York City.
These are not mutually exclusive. “It is possible to have a double- or triple-whammy, such as being obese and having misaligned hips, knees, or ankles,” he says. When any of your joints are not aligned, it places more stress on the joint.
“Matching the right treatment with the suspected origin from the start will lead to more success,” he says. “Let’s say a woman has never had an injury, but she is 50 pounds overweight, and it hurts her the most when she walks downstairs,” he says. In this case, weight loss and exercise are the recommended treatments.
Weight Loss and OA
Weight loss and exercise are underrated OA treatments, agrees David Pisetsky, MD. He is chief of rheumatology at Duke University Medical Center in Durham, N.C. “Before we even talk about medication, we want you to exercise more and lose weight if you need to.”
And we are not talking about massive weight loss. “Losing 5% to 10% of body weight is reasonable,” he says. Research has shown that for each pound of body weight lost, there is a 4-pound reduction in knee joint stress among overweight and obese people with knee OA.
Medication for OA Pain Relief
Weight loss and exercise will certainly help unload stress on the joints and reduce pain, but medications are often needed to break the OA pain cycle.
The first step with medication is often over-the-counter pain relievers, such as acetaminophen, ibuprofen, and naproxen. You can take them occasionally, as needed, for pain. Don’t take more than recommended on the label, as that may increase the risk of side effects.
If you find yourself needing over-the-counter pain relievers on most days, check with your doctor. A prescription anti-inflammatory drug may better ease your pain and swelling. Injections of strong anti-inflammatory steroids directly into specific joints are also effective for many but can be used only every few months. More frequent use may damage the joint cartilage.
Another OA treatment, viscosupplementation, involves injecting hyaluronic acid into the affected joint. Hyaluronic acid is naturally found in joint fluid, where it serves as lubricant. Unlike NSAIDs and steroids, these injections don’t take effect immediately.
Cymbalta, a medication originally used as an antidepressant, may also help with OA pain.
There is also a role for topical painkillers. These are available as creams, salves, or gels with a host of active ingredients including capsaicin which stems fromhot peppers. These can help if your pain is mild. They can also be used as an add-on with other medications to achieve maximum control of your OA pain.
Some researchers are experimenting with platelet-rich plasma (PRP). This entails extracting platelet cells from your own blood, and re-injecting them into the injured joint, stimulating your body's natural healing process. Experts don’t agree on its effectiveness and more research is needed to determine how helpful it is for OA.
Other OA Treatments
Medication on its own is often not enough. So what else can help? Physical and occupational therapy along with assistive devices such as knee braces, canes and/or shoe insoles can help correct joint misalignment, and strengthen muscles surrounding achy joints.
For example, people with knee OA are often told to strengthen the quadriceps muscle (the big muscle on the front of the thigh). This can help insulate the joint from stress. It’s best to learn the correct way to exercise from a physical therapist or trainer to avoid overdoing it and getting injured, Hillstrom says.
Occupational therapists pitch in by helping people with OA better navigate their home or work environments. They have many tools at their disposal, such as leg extenders that lengthen the legs of your office or dining room chair so that you don’t have to bend as deeply to sit.
Many people also turn to alternative therapies to treat OA. For years, much hope was pinned on the use of two supplements -- glucosamine and chondroitin -- to help OA pain and possibly slow joint destruction. Glucosamine and chondroitin are part of normal cartilage, which serves as a cushion between the bones in a joint. A large government-funded study looking at the benefits of this duo did not pan out. That said, some people do see relief with these supplements, Hillstrom says. “They can’t hurt you and they may help.” Several weeks of treatment is typically needed to see any effect.
SAMe is another supplement that has shown promise for easing OA pain. Multiple studies have shown that SAMe may work as well as anti-inflammatory pain relievers for decreasing OA symptoms. This may be particularly helpful for people who have trouble with side effects from anti-inflammatory drugs, particularly stomach upset. SAMe may take up to 30 days before you begin to notice improvement.
Some swear by acupuncture -- which involves stimulating certain channels or meridians along the body with fine needles to relieve pain. One large German study showed that acupuncture, when paired with usual medical care, reduced pain and stiffness, and improved function and quality of life among people with knee OA. These improvements were immediate, and lasted for at least six months.
Surgery for OA
Despite all of these options, some people with OA may still need joint replacement surgery. How do you know if you fall into this category? “It all comes down to pain,” says Duke’s Pisetsky. “How much pain are you in due to OA?”
He asks his patients to rate their pain with a 1-10 scale of ascending pain. “Most people can live with a three, but if we can’t get them into that range with conservative therapies, joint replacement surgery may be appropriate.” During these surgeries, the damaged joint is removed and replaced with an artificial one.
Still, joint replacement surgery is not right for everyone. “Surgeons are reluctant to operate on people who are overweight or obese because it increases the risks associated with any surgery, so weight loss is still indicated,” says Pisetsky.
