The most effective step toward controlling the symptoms of osteoarthritis is obtaining an early diagnosis and starting treatment as soon as possible. Non-surgical treatments are often sufficient for the management of physical symptoms and the preservation of daily functioning.

Osteoarthritis treatment programs typically include a combination of medication and exercise therapy.

Medications

Drug therapy is used to manage physical symptoms, with a focus on relieving pain and slowing progression of the disease. Some commonly used medications include:

  • Analgesics. Pain relievers, or analgesics, such as acetaminophen (e.g. Tylenol), or tramadol (e.g. Ultram) are used to relieve pain, but do not alleviate inflammation or swelling. Because they have few side effects, analgesics are recommended for patients experiencing mild to moderate pain.
  • Topical analgesics. Topical analgesics are creams that can be applied directly to the skin over the affected area. The primary ingredients in these creams are usually counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. Topical analgesics are available in most drug stores, and can be used in combination with most oral pain medications.
  • NSAIDs. Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), cox-2 inhibitors) are used to reduce swelling and inflammation, and are recommended for patients experiencing moderate to severe pain.
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Physical Therapy

Physical therapy provides targeted exercises that help maintain the ability to perform everyday tasks such as walking, bathing, and dressing. Although rest is an important part of the healing process, it is important to keep up with moderate levels of activity to strengthen the muscles surrounding the damaged joint. Stronger muscles provide greater stability for the joint, which in turn helps reduce stress on the joint.

Occupational therapy may also be recommended to demonstrate appropriate modifications for everyday activities that may be causing pain.

Injections

Steroid injections are often performed if pain is moderate to severe and especially if the pain symptoms limit the patient’s ability to participate with exercises. When combined with physical therapy, steroid injections can offer a very important "window of opportunity" during which the patient may more fully participate with therapy because the pain is resolved or at least better controlled. By allowing the patient to participate with therapy, the patient may stretch and strengthen important muscles around the affected joint(s) and thereby decrease the load experienced by the joint(s) so that the inflammation and pain do not return.

Hyaluronic acid injections are another injection modality designed to help lubricate the joint and reduce the pain and inflammation of the joint. These injections attempt to help replace the joint’s natural fluid and are sometimes described as "paving the pot holes in the joint." By reducing the inflammation and pain in the joint, as with steroid injections, a "window of opportunity" is opened up for the patient to stretch and strengthen the appropriate muscles. If the patient does not use this window, then often symptoms recur in 6-12 months at which point the injections can be repeated if necessary.

Surgery

For most patients, osteoarthritis symptoms can be successfully managed through non-surgical care. For some, however, if they are experiencing severe joint damage, extreme pain, or very restricted mobility, surgery may be a viable option. Common types of surgery for osteoarthritis of the hip or osteoarthritis of the knee include arthroscopic surgery, osteotomy, and arthroplasty (total joint replacement).

While the potential benefits of surgery, such as improved movement and pain relief, can be enticing, it is important to remember that any surgery comes with risks. These risks are higher for patients who are overweight or have other co-morbidities, which is a concern for many osteoarthritis sufferers.

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Written by Grant Cooper, MD
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