Osteoarthritis (OA)

Appropriate exercises—including stretching, strengthening, and postural exercises—help maintain healthy cartilage, increase a joint’s range of motion, and most importantly strengthen surrounding muscles so that they can absorb stress better. Exercise can sometimes slow down the worsening of osteoarthritis of the hip and knee. Doctors often recommended people exercise in water (such as in a pool) because water spares the joints from stress.

Stretching exercises should be done daily.

Exercise must be balanced with a few minutes of rest of painful joints (every 4 to 6 hours during the day), but immobilizing a joint is more likely to worsen the disease than relieve it.

Using excessively soft chairs, recliners, mattresses, and car seats may worsen symptoms.

People should not put pillows under their knees when reclining because doing so can cause the hip and knee muscles to become tight. (This recommendation contrasts with the recommendation that people with low back pain and sciatica put a pillow between their knees. For such people, using a pillow relieves the stress on the lower back and hip [see Sciatica Sciatica Sciatica is pain along the sciatic nerves. These nerves run from the lower back, through the buttocks, and down the legs, ending just below the knee. A herniated disk, complications of osteoarthritis... read more ].)

Moving car seats forward, using straight-backed chairs with relatively high seats (such as kitchen or dining room chairs), firm mattresses, and bed boards (available at many lumber yards), and wearing orthotics, supportive shoes, or athletic shoes are often recommended.

Toilet seat risers can make standing up easier and less uncomfortable for people who have painful osteoarthritis of the knees or hips, particularly if their muscles are weak.

For osteoarthritis of the spine, specific exercises sometimes help, and back supports may be needed when pain is severe. Exercises should include both muscle-strengthening as well as low-impact aerobic exercises (such as walking, swimming, elliptical machine use, and stationary bicycle riding). If possible, people should maintain ordinary daily activities and continue to perform their normal activities, such as a hobby or job. However, physical activities may have to be adjusted to limit lifting and bending in ways that can aggravate the pain of osteoarthritis.

Other additional measures can help relieve pain and help people live with osteoarthritis. They include

Medications are used to supplement exercise and physical therapy. Medications, which may be used in combination or individually, do not directly alter the course of osteoarthritis. They are used to reduce symptoms and thus allow more normal daily activities.

A pain reliever (analgesic), such as acetaminophen, used before activities that cause discomfort or used regularly to relieve more constant joint discomfort, may be all that is needed for mild to moderate pain. Although side effects are not common, people should not take acetaminophen in higher than recommended doses, particularly if they have liver disease or drink considerable alcohol. When taking acetaminophen, people should also make sure not to simultaneously take one of the numerous over-the-counter drug products that contain acetaminophen.

Sometimes, however, people may need a more potent analgesic, such as tramadol.

Alternatively, a nonsteroidal anti-inflammatory drug (NSAID) Nonsteroidal Anti-Inflammatory Drugs Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more may be taken to lessen pain and swelling. NSAIDs reduce pain and inflammation in joints and can be used in combination with other analgesics. NSAIDs also come in gel and cream forms that can be rubbed into the skin (such as diclofenac gel 1%) over the joints of the hands and knees and may help relieve symptoms. However, NSAIDs have a higher risk of serious side effects than acetaminophen when used long term. People who take NSAIDs by mouth often also take a medication to protect the stomach lining and also may have their kidney function and blood pressure monitored.

Sometimes other types of pain medicine may be needed. For example, a cream made from cayenne pepper—the active ingredient is capsaicin—can be applied directly to the skin over the joint. Doctors may also recommend lidocaine patches for pain relief, but there is no evidence these patches are effective. Duloxetine, a type of antidepressant taken by mouth, may reduce the pain caused by osteoarthritis.

Muscle relaxants (usually in low doses) occasionally relieve pain caused by muscles straining to support joints affected by osteoarthritis. In older people, however, they may cause more side effects than relief.

If a joint suddenly becomes inflamed, swollen, and painful, most of the fluid inside the joint may need to be removed and a special form of cortisone may be injected directly into the joint. This treatment may provide temporary pain relief and increased joint flexibility in some people.

A series of 1 to 5 weekly injections of hyaluronate (a substance similar to normal joint fluid) into the knee joint may provide some pain relief in some people for prolonged periods of time. These injections should not be given more often than every 6 months. Hyaluronate injections are less effective in people with severe osteoarthritis and do not slow the progression of the arthritis.

Several nutritional supplements (such as glucosamine sulfate and chondroitin sulfate) have been tested for potential benefit in treating osteoarthritis. So far, results are mixed, and the potential benefit of glucosamine sulfate and chondroitin sulfate in treating pain is unclear, and they do not seem to change the progression of joint damage. There is no good evidence that any other nutritional supplements work.

Surgical treatment may help when other treatments fail to reduce pain or improve function. Some joints, most commonly the hip and knee, can be replaced with an artificial joint. Replacement, particularly of the hip, is usually very successful, almost always improving motion and function and dramatically decreasing pain. Therefore, joint replacement should be considered when pain is unmanageable and function becomes limited. Because an artificial joint does not last forever, the procedure is often delayed in very young people so the need for repeated replacements can be minimized. If other treatments are ineffective, surgical procedures can be done to help relieve symptoms of back or neck osteoarthritis, particularly nerve compression. The benefit of limited, arthroscopic surgical procedures for osteoarthritis of the knee, such as repair of the meniscus or reconstruction of knee ligaments, is uncertain.

A variety of methods that restore cells inside cartilage have been used in younger people with osteoarthritis (often caused by an injury) to help heal small defects in cartilage. However, such methods have not yet proved valuable when cartilage defects are extensive, as commonly occurs in older people.