While there's no cure for osteoarthritis, you can still do much to relieve pain and stay active. Your osteoarthritis treatment will depend on several factors, including the severity of your pain -- and how much it affects your everyday activities.
Osteoarthritis often progresses slowly, with periods when there's little or no change. If you have mild-to-moderate osteoarthritis, you can probably control your symptoms with nonprescription pain relievers. When those don't work, your doctor will advise you on the next steps in your osteoarthritis treatment.
Medications for Osteoarthritis Treatment
Analgesics: Drugs like Tylenol, which contains acetaminophen, relieve mild-to-moderate pain with few side effects in most people. Tylenol is typically the first drug people take for treatment of osteoarthritis pain.
Topical pain relievers: Creams, salves, or gels are analgesics that relieve mild pain when just a few joints are involved -- like your hand. They can also be used in addition to oral painkillers. Active ingredients include capsaicin (found naturally in hot peppers), camphor, eucalyptus oil, menthol, and salicylates. ArthriCare, Aspercreme, BenGay, Capzasin-P, Eucalyptamint, Flexall, Icy Hot, and Zostrix are all topical pain relievers for osteoarthritis treatment.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs relieve pain by blocking chemicals that cause inflammation. They are reasonably safe drugs -- but, because of potential side effects like stomach irritation and gastrointestinal bleeding, it's best to take low doses for brief periods. Over-the-counter NSAIDs include: Advil, Aleve, Anacin, Aspirin, Bayer, and Motrin.
Glucosamine-chondroitin supplements: These compounds are natural substances found in joint fluid. They are thought to trigger cartilage production and reduce inflammation. The latest studies show potential in slowing the progression of knee osteoarthritis and relieving moderate-to-severe osteoarthritis pain.
Prescription NSAIDS: These are stronger versions of NSAID painkillers, and are prescribed when simple over-the-counter pain relievers aren't effective. These are reasonably safe, but there are potential side effects when taken in large doses over months or years. The FDA requires a label warning of risks like heart attack, stroke, and stomach bleeding. Clinoril, Disalcid, Feldene, Indocin, Lodine, Mobic, and Relafen are prescription NSAIDs.
Cox-2 drugs: This newer type of NSAID was developed to relieve inflammation without the stomach irritation of traditional NSAIDS. These drugs are reasonably safe, but there is still some risk to the stomach. The FDA requires a label warning of increased risk of cardiovascular side effects and gastrointestinal bleeding. Two other Cox-2 drugs were removed from the market because of increased risk of stroke, heart attack, and life-threatening skin reactions. Celebrex is the only Cox-2 drug still on the market and is prescribed in osteoarthritis treatment.
Steroid injections: Quick pain relief is possible when glucocorticoids (a type of steroid) are injected into the joint for osteoarthritis treatment. These are typically advised for moderate-to-severe knee pain or for inflammation that is not relieved by an NSAID.
Hyaluronan injections: Hyaluronic acid is a substance found in joint fluid. Given as weekly injections directly into the joint, it increases mobility. Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc are approved for mild-to-moderate knee arthritis.
Narcotic pain relievers: These strong pain relievers contain narcotics and are often combined with Tylenol. The drugs work on pain receptors on nerve cells, not on inflammation. There is risk of dependency with these drugs. They include: Darvocet, Darvon, Lorcet, Lortab, Morphine, Oxycontin, Percocet, Tylenol with Codeine, and Vicodin.
Osteoarthritis Treatment: The Next Stage
If you have severe joint damage, severe pain, or very limited motion because of osteoarthritis, you may need surgery. These procedures relieve pain and allow better mobility:
Arthroscopic surgery: A common outpatient surgical procedure for knees and shoulders, this allows surgeons to repair the surfaces of damaged joints -- removing loose cartilage, repairing cartilage tears like meniscus tears, and smoothing bone surfaces.
Radiofrequency ablation (RFA): Electrical current is used to heat a small area of nerve tissue, which decreases pain signals from that tissue. The degree of pain relief varies, but this osteoarthritis treatment is proven helpful in relieving pain from joint damage.
Joint replacement surgery: When nothing else has worked, the damaged joint can be replaced with an artificial one. Hips and knees are most commonly replaced, but artificial joints are now available for shoulders, fingers, elbows, and back joints.
Osteotomy: When someone is too young for joint replacement, this procedure can increase stability in a knee or hip joint. It involves cutting bone to redistribute weight on a joint, making it more stable.
Joint fusion: Also called arthrodesis, this surgery involves fusing two bones on each end of a joint -- thus eliminating the joint itself. It is used when joints are severely damaged, causing significant pain. It is also done when joint replacement is not effective, as with the ankle. Though the fused joint is not flexible, it is more stable, can bear weight better, and is no longer painful -- the main points of osteoarthritis treatment.