How to treat arthritis

There are many different types of arthritis and treatments differ according to type - but pain relief medications are helpful for many symptoms.

Some of the main treatments for specific types of arthritis include:

• Osteoarthritis - weight loss, exercise, physiotherapy, and sometimes surgery.

• Inflammatory arthritis (rheumatoid arthritis) - often treated with medicines that stop the immune system from damaging the joints.

• Gout - often treated with medicines to reduce the levels of uric acid in the blood.

• Septic arthritis (infection) - requires antibiotics and sometimes surgery to clear the infection.

If you think you have arthritis find out what to do here. This will tell you if you need to see a doctor and how to treat it.

In this series of articles centred around arthritis you can read about arthritis causes, arthritis symptoms, and arthritis treatment - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatments of arthritis as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

How to treat arthritis

Here are the main types of arthritis and their treatments.

Osteoarthritis

Osteoarthritis is the most common type of arthritis. Treatments include:

• Regular exercise - exercising regularly can help to improve muscle strength, preserve joint mobility, and improve symptoms of osteoarthritis such as pain and stiffness. Some types of exercise can worsen osteoarthritis pain, so low-impact exercises like swimming and cycling are generally preferred.

• Weight loss - if overweight or obese this helps to reduce the stress on weight - bearing joints.

• Pain-relieving medicines - such as non-steroidal anti-inflammatory drugs (NSAIDs), which come as gels, creams, tablets, and capsules and paracetamol.

• Physiotherapy can help some symptoms.

• Steroid injections into affected joints can produce short-term relief.

• Surgery - if other treatments haven't worked, and the symptoms are severe, surgery, such as joint replacement, can sometimes help.

See osteoarthritis treatment for more detail.

Autoimmune conditions

Some types of arthritis are caused by autoimmune conditions - sometimes called inflammatory arthritis. There are lots of different causes of inflammatory arthritis, all of which have different patterns of symptoms. The treatments also differ from condition to condition but generally aim to reduce long term joint inflammation and damage.

Rheumatoid arthritis is one of the most common types of inflammatory arthritis. There are some similarities in how other types of inflammatory arthritis are treated but rheumatoid arthritis treatments include:

• NSAIDs - such as ibuprofen or naproxen, to reduce pain and stiffness in affected joints.

• Steroid tablets or sometimes steroid injections into a joint - steroids are useful to settle down joint inflammation quickly, but have many side-effects, especially when used for a long time, so are ideally used for short courses only.

• Disease-modifying antirheumatic drugs (DMARDs) - control the immune system and stop it from attacking the joints. DMARDs are an important long-term treatment, as they treat the underlying condition, not just the symptoms, and can help prevent further joint damage. DMARDs include methotrexate, leflunomide, and sulfasalazine, and newer biologic therapies such as infliximab, etanercept, and adalimumab.

• Physiotherapy.

• Surgery - sometimes needed if there is severe joint damage but less common now as DMARDs have become more effective.

Rheumatoid arthritis treatment is generally overseen by a rheumatologist - a specialist in autoimmune joint conditions.

See rheumatoid arthritis for more information.

Gout

Gout is a common cause of sudden and severe joint pain. Treatments for gout include:

• Treatments to ease the pain during a flare of gout:

  • NSAIDs.

  • Colchicine - a medicine which reduces the inflammation and pain of a gout attack.

  • Steroid tablets - generally used if NSAIDs and colchicine aren't working, or can't be used.

  • Steroid injections - sometimes can be used.

• Treatments to stop gout coming back - sometimes called gout prophylaxis:

  • Lifestyle changes - weight loss if overweight or obese, stopping smoking, reducing alcohol intake, and avoiding or reducing gout-causing foods.

  • Allopurinol - a medicine which reduces the amount of uric acid in the blood. High levels of uric acid cause gout to occur.

  • Colchicine - often used when first starting allopurinol, as starting allopurinol can trigger an attack of gout, and colchicine reduces the chance of this happening.

  • Febuxostat - an alternative for people who cannot use allopurinol.

There is also a condition which has similar symptoms to gout, called calcium pyrophosphate deposition (CPPD) - sometimes called pseudogout. Treatment for CPPD is generally only for symptom control, such as anti-inflammatory drugs, steroid injections, and sometimes colchicine.

Septic arthritis

Septic arthritis is infection of a joint and must be treated in hospital urgently, to prevent further damage to the joint. Treatments for septic arthritis include:

• Antibiotics - given through a drip into the vein initially. Tablet antibiotics are often needed for several weeks after leaving hospital.

• Drainage of infected fluid from the joint - for example, surgery to wash out the joint with sterile saline.

• Surgery - infections of joint replacements (prosthetic joints) may require surgery to remove the infected joint, and replace it with a new one.

Patient picks for Arthritis

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What foods are good for arthritis?

What we eat can help to relieve the symptoms of many health conditions, including arthritis. Although there is no miracle diet for arthritis, certain foods can help fight inflammation and support your joint health, such as fatty fish, fruit, vegetables, and nuts.

by Lydia Smith

Bones, joints and muscles

Reactive arthritis

Reactive arthritis is a type of arthritis in which you develop inflammation in joints after you have had an infection in some other part of the body. For example, after a bad bout of diarrhoea you might develop a sore knee a couple of weeks later. Symptoms commonly last between a few weeks and a few months. Anti-inflammatory medicines usually ease the pain. Other treatments are sometimes needed. This is an unusual condition that would usually be managed by a specialist.

by Dr Rosalyn Adleman, MRCGP

Can arthritis be cured?

Most types of arthritis are long-term conditions and can't be completely cured. However, treatments can help to control the cause of the arthritis and stop the symptoms impacting upon daily life.

Arthritis complications

Arthritis can affect daily life in many ways, particularly if it becomes severe enough to affect the way in which joints work. Pain and stiffness might stop people from being able to walk or run normally.

Arthritis affecting the hands might make it difficult for people to perform delicate tasks, such as opening jars or using taps. Arthritis affecting the hips and knees can make it difficult to get around without assistance. Living with a long-term condition can affect people's mental health, leading to depression and anxiety.

However, there are many treatments that can stop this happening or treat symptoms if they do become severe. Occupational therapists and physiotherapists can help people whose arthritis is affecting their daily lives.

Some types of inflammatory arthritis have other complications, because the immune system can affect other connective tissues and other organs. For example, rheumatoid arthritis can cause carpal tunnel syndrome, and sometimes inflammation in the heart, lungs, eyes, and blood vessels.

Tips for managing arthritis at home

Things you can try for managing arthritis at home include:

• Staying mobile with regular exercise - as pain allows, try stretches, progressive strength training and low-impact exercise, such as swimming, cycling, or walking. These are all good to strengthen the muscles around joints, helping with pain, function, and stiffness.

• Stopping smoking - smoking makes some forms of arthritis worse, for example, rheumatoid arthritis. There is also evidence that it might make osteoarthritis worse.

• Maintaining a healthy weight, or losing weight if overweight or obese - this reduces the stress on weight-bearing joints.

• Warmth and cold - some people find applying warmth, such as using a heating pad, is good for reducing pain. Others find that cold - such as using an ice pack - helps.

• Over-the-counter pain relief - medicines such as paracetamol or NSAIDs can help. It's best to speak to a doctor if you find that you need to take these often, as they have side-effects, and you might be advised to use different medicines alongside them.

Further reading

• Arthritis Foundation.

• Versus Arthritis.

• Pain Management; Arthritis Action.