Osteoarthritis Treatment and Symptom Management

Osteoarthritis is a disease that most often develops slowly as the result of the wear and tear of cartilage, which normally provides shock absorption for the joints.

Because of this gradual development, the symptoms of osteoarthritis — the hallmarks of which are joint pain and stiffness, especially in the morning — tend to get worse over time.

Some treatments can help to reduce symptoms, but no treatment can reverse or slow the degradation of cartilage.

Treatment options for osteoarthritis typically depend on the severity of the condition and the particular joints involved. They most often include:

• Medication
• Physical activity, stretching, and weight management
• Physical and occupational therapy, with or without assistive devices
• Surgery (1)

There are many types of medication available to help treat osteoarthritis. For the most part, these serve to reduce joint pain and inflammation.

Some common treatments include:

Analgesics Analgesics are medicines that help relieve pain.

Some analgesics, such as acetaminophen (Tylenol), are available over the counter and may be effective for treating mild to moderate arthritis pain.

An atypical opioid called tramadol (Ultram) is sometimes used for osteoarthritis pain. But a literature review found that while tramadol and paracetamol can decrease pain, relieve symptoms, and improve function, the overall benefits are small. (2)

Other prescription narcotics, such as codeine, morphine, and others, may be used for short periods of time to relieve sudden, severe arthritis pain, but narcotics are not good options for long-term or chronic pain.

One review found that these non-tramadol opioids also provide small benefits, but they increase the risk of serious side effects. (3)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Many of the nonprescription drugs available for treating osteoarthritis fall into the category of NSAIDs.

These medicines relieve pain and reduce swelling and inflammation. They include drugs such as ibuprofen (Advil), naproxen (Aleve), celecoxib (Celebrex), and aspirin.

These drugs are typically recommended at their lowest effective dose for the shortest duration possible because they can cause side effects over time, such as ulcers, cardiovascular disease, and renal disease.

Topical NSAIDs, such as diclofenac (Voltaren), are also available to relieve osteoarthritis pain, particularly of the hands and knees. (1)

Joint Injections Glucocorticoids are steroids that can help relieve arthritis pain and inflammation when injected into an arthritic joint. But these drugs are used sparingly because they can damage certain joints if used repeatedly.

A medication called hyaluronate can also be injected into the knee to act as a lubricant in the joint, but it’s generally not recommended due to a lack of efficacy evidence and high cost. (1)

Colchicine (Colcrys) Some doctors may recommend colchicine for people whose knee osteoarthritis flares are resistant to other treatments.

But a 2017 study found that the drug is not effective in reducing symptoms of knee osteoarthritis. More research is necessary to prove its efficacy. (4)

Hydroxychloroquine (Plaquenil) Hydroxychloroquine affects the immune system and might help reduce inflammation in some people. But a 2018 study found that the drug is not effective for hand osteoarthritis. (5)

Physical Therapy and Exercise for Osteoarthritis

Physical therapy and exercise programs can help many people with osteoarthritis improve their flexibility and range of motion. Such activity can also help strengthen the muscles around the joint.

Physical and occupational therapy can teach you how to properly use your joints to avoid making symptoms worse and how to increase your range of motion. (1,6)

Assistive Devices for Help With Daily Movement and Activities

Your physical therapist may also recommend assistive devices to help you with your daily activities. These devices can include scooters, canes, walkers, splints, shoe orthotics, jar openers, long-handled shoe horns, or steering wheel grips.

People who exercise or move regularly with the help of a physical therapy program typically have less joint pain and better joint function than those who are inactive.

Exercise programs may also help with weight loss. Even moderate weight loss in overweight people has been shown to help reduce joint pain in the knees and hips.

Engaging in specific exercises can especially help with knee osteoarthritis (the most common type of osteoarthritis), including:

• Knee-strengthening exercises
• Hip-strengthening exercises
• Low-impact activities
• Flexibility-improving activities (7)

Surgery for Treating Osteoarthritis

If your arthritis pain hasn’t gotten better with other treatments, your doctor may recommend surgery.

In a joint replacement surgery, your surgeon will remove the arthritic joint and replace it with prosthetic components made of metal, plastic, or ceramic. Total joint replacement surgeries are performed to replace the knee, hip, shoulder, ankle, or elbow.

There are several other surgical treatments for osteoarthritis. For instance, surgery to permanently fuse two or more bones together at a joint may be recommended for the wrist, ankle, spine, or small joints of the fingers and toes. (8)

Your surgeon may also choose to perform a realignment for knee osteoarthritis, in which the surgeon shifts weight bearing to healthier cartilage in your affected knee. (1)

Doctors perform arthroscopic knee surgery — a type of surgery that involves small incisions and a tiny camera — for knee osteoarthritis in countries throughout the world, including the United States. But in 2017, an international panel of experts strongly recommended against the procedure for people with degenerative knee disease, including osteoarthritis. (9)

Complementary and Alternative Therapies for Treating Osteoarthritis

Complementary and alternative treatments for osteoarthritis may be used in conjunction with standard treatments to reduce symptoms.

Common alternative therapies for osteoarthritis include:

Acupuncture In general, studies suggest that acupuncture can help relieve knee osteoarthritis pain. (10)

Glucosamine (Genicin) and Chondroitin Sulfate These nutritional supplements have received a lot of attention as potential symptom relievers for osteoarthritis. But overall, research has not shown much benefit for glucosamine or chondroitin sulfate for osteoarthritis when used individually or together. (1,10)

Heat and Cold Heat and cold therapy, applied with warm towels or hot packs and ice packs, may help to ease pain and stiffness and reduce inflammation. (12)

Transcutaneous Electrical Nerve Stimulation (TENS) This technique uses a small electronic device to send electrical impulses to nerve endings in the painful area. It may help relieve some kinds of arthritis pain, though more research is needed to fully show its efficacy and the most appropriate treatment regimen for osteoarthritis. (13)

Numerous other complementary and alternative treatments are available for osteoarthritis, though the quality and quantity of evidence is generally low and more research is needed. These treatments include:

• Tai chi
• Yoga
• Massage therapy
• Balneotherapy (bathing in mineral water)
• Magnet therapy
• Cupping (10)
• Fish oil (14)