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How to treat osteoarthritis

How to treat osteoarthritis

Osteoarthritis is the most common cause of arthritis, and typically affects older adults. It causes pain and stiffness of affected joints. Osteoarthritis typically affects the knees, hips, hands and spine, although it can affect other joints too. Diagnosing osteoarthritis is based on typical symptoms and examination findings. Tests like X-rays and blood tests often aren't needed, but can sometimes be useful to look for other conditions. Osteoarthritis treatments include maintaining a healthy weight, exercise, pain-relieving medication such as non-steroidal anti-inflammatory drugs (NSAIDs), and sometimes other treatments such as joint injections and surgery.

Treatments for osteoarthritis include:

  • Exercise.
  • Physiotherapy.
  • Weight loss if overweight or obese.
  • Medications to relieve pain.
  • Assistive devices from an occupational therapist.
  • Joint injections.
  • Joint surgery, including joint replacement surgery.

If you think you may have osteoarthritis find out what to do here. Osteoarthritis is one of the causes of arthritis. See here for more detail.

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

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

How to treat osteoarthritis

There are many different treatments for osteoarthritis, depending on the joints affected by osteoarthritis, and how severe the symptoms are.

Exercise

Staying active and exercising regularly are important for improving symptoms of osteoarthritis. Physical activity helps to strengthen muscles and joints, can help with weight loss, and is good for physical and mental health. It's best to combine muscle-strengthening exercises with general fitness - aerobic or cardiovascular - exercise.

Exercise can initially make osteoarthritis pain worse. However, in the longer term, it is effective at reducing osteoarthritis pain, increasing the function of affected joints, and improving quality of life.

It's a good idea to build up gradually when starting an exercise programme. Low-impact exercises - like walking, cycling, Pilates, and yoga - are good as they don't put as much stress on the joints.

There are also special exercises that can help to strengthen affected joints and reduce pain1. Physiotherapists may also recommend specific exercises.

Weight loss

If someone with osteoarthritis is overweight or obese, losing weight can help by reducing pain and other symptoms of osteoarthritis. Carrying extra weight puts additional strain on weight-bearing joints, like the hips, knees, and spine. This can cause further injury to already damaged joints.

Achieving a healthy weight also has lots of other health benefits. See weight loss for more ideas on how to work on this.

Physiotherapy

Physiotherapists can assess and treat people with osteoarthritis. They may advise specific exercises to improve symptoms, and might be able to offer physical therapy such as stretching and joint manipulation.

Pain-relieving medications

Medications can help treat pain from osteoarthritis. This can help people to do therapeutic exercises. Medications that might be useful include:

  • Paracetamol - there is not much evidence that paracetamol improves osteoarthritis pain. However, paracetamol, when taken at the correct doses, is a safe drug with few side-effects, so it may be worth trying in case it does work for some people.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - there is evidence that these do help with pain from osteoarthritis. These come as gels or creams which can be rubbed directly on to the skin - these are particularly useful for hand or knee osteoarthritis - and tablets or capsules. NSAIDs, particularly the tablets and capsules, do have side-effects - for example, they can cause stomach irritation and stomach ulcers that can bleed, kidney damage, and heart problems, and can make asthma worse in some people. It's best, therefore, to use these at the lowest dose needed and for the shortest time possible. Speak to a doctor if you feel you need to use NSAIDs regularly, as they may offer other treatment, such as stomach-protecting drugs.
  • Capsaicin gel - derived from chili peppers, it can be rubbed on to the skin over affected joints.
  • Drugs such as codeine or tramadol - have various different side-effects, including drowsiness, constipation, and nausea, and so are usually only used if pain is troublesome and there are no better options available.

Assistive devices - or self-help devices

Self help devices might be recommended by an occupational therapist, but some of them can also be bought in shops or online. If osteoarthritis symptoms are making it difficult to do certain daily tasks, these can help. Examples include:

  • Custom shoes or insoles to correct walking issues.
  • Canes, walking sticks, crutches, and walkers - if osteoarthritis pain is making walking difficult.
  • Tin can, bottle, and jar openers for hand pain or grip issues.
  • Eating utensils with enlarged handles, for easier use.

Steroid injections

These can be used for osteoarthritis in certain situations. Steroid injections are most often used in knee osteoarthritis, but can be given into other joints too. They contain a medicine called corticosteroid - which is different to anabolic steroids - which reduces inflammation and therefore pain in the joint. They're often also mixed with a local anaesthetic - a numbing drug - because the injection can initially make pain worse.

Steroid injections give relatively short-term pain relief. The effect usually wears off within about three months, although it can wear off sooner for some people. Because of this, they're generally best used for short-term symptom relief to allow people to engage in other treatments, such as exercise and physiotherapy. They can also be useful for people with severe osteoarthritis who can't, or don't want to, have an operation.

Steroid injections have risks, such as causing increased pain and swelling in the joint for a few days. There are also some rare but potentially serious risks, such as developing an infection in the joint. Repeated steroid injections can also weaken the joint and the tissues around it, so, it's recommended to leave at least three months between injections and to have no more than four injections in a joint per year.

Transcutaneous electrical nerve stimulation (TENS) machines

Some people find that using a TENS machine can help with osteoarthritis pain. These are thought to block pain signals from nerves that supply the joint. These might be recommended by a physiotherapist or a pain specialist.

Hot or cold packs

Some people find that using a heat pack - or, conversely, using an icepack - applied directly to a joint helps with their symptoms.

Surgery

Most people with osteoarthritis can manage their symptoms with other treatments, and don't need surgery. However, surgery can be an option if symptoms are severe, and other treatments haven't worked. Surgery generally improves symptoms, but usually doesn't completely get rid of them.

Surgeries are performed by orthopaedic surgeons, who can advise on whether surgery is an option, and also what the benefits and risks are. Examples of surgeries for osteoarthritis include:

  • Joint replacement surgery - most commonly done for the hip or knee.
  • Surgery to remove bone from a joint (osteotomy) - can help to correct the shape of a joint if there is a problem with it. It might be done for younger people with problems with joint structure, such as people born with hip joint problems.
  • Joint fusion (arthrodesis) - can be used to fix a joint in place, if joint replacement is not an option. This results in a joint that is less painful, and stronger, but can't be moved.
  • Joint resurfacing surgery - sometimes used as an alternative to joint replacement in the hip. Instead of replacing the entire joint, the bone is trimmed and covered with a smooth metal cap. There's much debate about this operation - research is ongoing to try to determine if it works well and how it compares to joint replacements.

Can osteoarthritis be cured?

Unfortunately, there's no way to cure osteoarthritis completely. However, treatments can help bring symptoms under control. Osteoarthritis doesn't always get worse over time, either.

Osteoarthritis complications

Osteoarthritis isn't a life-threatening condition. However, it can cause significant problems for people who have it.

Osteoarthritis can lead to chronic (long-lasting) pain. It can affect activities of daily living - for example, making it difficult to walk, or to use the hands. In older people, the pain and muscle weakness can lead to a risk of falls.

Living with a chronic condition like osteoarthritis can lead to mental health issues, like depression and anxiety.

Further reading

  1. Exercises for healthy joints; Versus Arthritis.
  2. Osteoarthritis; NICE CKS, August 2022 (UK access only).
  3. Fransen M, McConnell S, Harmer AR, et al; Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015 Jan 9;1:CD004376. doi: 10.1002/14651858.CD004376.pub3.
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