How is osteoarthritis treated

OA is often a slow-developing disease that can be hard to diagnose until it starts to cause painful or debilitating symptoms. Early OA is often diagnosed after an accident or other incident that causes a fracture requiring an X-ray.

This imaging test uses radio waves and a magnetic field to create images of bone and soft tissue. Other diagnostic tests include a blood test to rule out other conditions that cause joint pain, such as RA. A joint fluid analysis can also be used to determine whether gout or infection is the underlying cause of inflammation. Check out the other tests used to help diagnose osteoarthritis.

OA treatment is centered upon symptom management. The type of treatment that will help you the most will largely be determined by the severity of your symptoms and their location. Often, lifestyle changes, over-the-counter OTC medication, and home remedies will be enough to provide you with relief from pain, stiffness, and swelling.

Physical activity strengthens the muscles around your joints and may help relieve stiffness. Aim for at least 20 to 30 minutes of physical movement, at least every other day. Choose gentle, low-impact activities, such as walking or swimming. Tai chi and yoga can also improve joint flexibility and help with pain management. Shop for yoga mats. Being overweight can put strain on your joints and cause pain.

Shedding excess pounds helps relieve this pressure and reduces pain. A healthy weight can also lower your risk of other health problems, such as diabetes and heart disease. Resting your muscles can reduce swelling and inflammation. Getting enough sleep at night can also help you to manage pain more effectively. You can experiment with heat or cold therapy to relieve muscle pain and stiffness. Apply a cold or hot compress to sore joints for 15 to 20 minutes several times a day.

These practices can help take the edge off of your symptoms and improve your quality of life. For a full list of OA treatments, learn more here. Gentle stretching exercises can be very helpful for people with OA, especially if you have stiffness or pain in your knees, hips, or back. Stretching can help improve mobility and range of motion. If stretching exercises get the green light, try these four osteoarthritis exercises.

There are a number of different types of OA medications that can help provide relief from pain or swelling. They include:. Your doctor may recommend you try OTC solutions as a first line of defense. Learn more about the OTC and prescription options for osteoarthritis. Alternative treatments and supplements may help to relieve symptoms such as inflammation and joint pain. Some supplements or herbs that may help include:. Shop for fish oil. Shop for green tea. Other remedies can range from taking Epsom salt baths to using hot or cold compresses.

Interested in more natural home remedies for OA? Also, the antioxidants found in many fruits and vegetables may also help combat the free radicals produced by inflammation. Free radicals are molecules that can cause cell damage. A high-quality diet may help provide relief from OA symptoms by reducing inflammation and swelling.

Eating foods high in the following can be highly beneficial:. Increasing your intake of foods with anti-inflammatory properties will help, too. During hip replacement surgery, your surgeon removes the diseased or damaged parts of your hip joint and inserts the artificial joint. One of the most common reasons for knee replacement surgery is severe pain from joint damage caused by wear and tear arthritis osteoarthritis.

Osteoarthritis can erode the slick cartilage that helps your knee joint move smoothly. An artificial knee joint has metal alloy caps for your thighbone and shinbone, and high-density plastic to replace damaged cartilage. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Learn all you can about your condition and how to manage it, especially about how lifestyle changes can affect your symptoms. Exercising and losing weight if you're overweight are important ways to lessen the joint pain and stiffness of osteoarthritis. Low-impact exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Try walking, bicycling or water aerobics.

If you feel new joint pain, stop. New pain that lasts for hours after you exercise probably means you've overdone it, not that you've caused damage or that you should stop exercising. Try again a day or two later at a lower level of intensity. Movement therapies. Tai chi and yoga involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to reduce stress in their lives, and research suggests that tai chi and yoga might reduce osteoarthritis pain and improve movement.

Make sure the yoga you choose is a gentle form and that your instructor knows which of your joints are affected. Avoid moves that cause pain in your joints. Assistive devices. Applying hot or cold packs to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.

Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way. If osteoarthritis is causing mobility problems or making it difficult to do everyday tasks, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.

If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes. Footwear with shock-absorbing soles can help relieve some of the pressure on the joints in your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.

If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.

A splint a piece of rigid material used to provide support to a joint or bone can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly. If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap.

Special devices, such as tap turners, can make performing these tasks more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace. Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis.

Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep your joints supple and flexible. Find out more about physiotherapy. Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where one of your joints is severely damaged.

If you need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life.

However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness from your condition. Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints.

During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint prosthesis made of special plastics and metal. An artificial joint can last for up to 20 years, although it may eventually need to be replaced.

There's also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best. Find out more about hip replacement and knee replacement. If joint replacement is not suitable for you, your surgeon may suggest an operation to fuse your joint in a permanent position, known as an arthrodesis.

All patients with osteoarthritis should receive at least some treatment from the first two categories. Surgical management should be reserved for those who do not improve with behavioral and pharmacologic therapy, and who have intractable pain and loss of function. Clinical practice guidelines have been recommended by American and British specialty societies. Recommended stepped-care approach for the treatment of osteoarthritis. Nonpharmacologic therapy often starts with exercise.

A randomized clinical trial compared supervised home-based exercise with no exercise in patients with osteoarthritis of the knee. The exercise program consisted of muscle strengthening and range-of-motion exercises. The researchers found statistically significant improvements in a validated arthritis symptom score at six, 12, 18, and 24 months.

A Cochrane review of exercise for osteoarthritis of the knee concluded that land-based exercise can result in short-term reduction of pain and improvement in physical function. The supervised exercise program had better short-term outcomes, but the differences were no longer noted at 36 weeks.

Therapeutic ultrasound is a physical therapy modality often used in osteoarthritis treatment. A Cochrane review of this modality concluded that although statistically significant improvements were noted in visual analog pain scales following therapeutic ultrasound for knee osteoarthritis, the clinical significance of these changes is questionable.

A Cochrane review on transcutaneous electrical nerve stimulation found no clinically significant improvement in knee osteoarthritis pain. Because obesity is considered a major risk factor for osteoarthritis, studies have investigated whether weight loss improves patient outcomes. A meta-analysis of weight reduction and knee osteoarthritis concluded that weight loss of 5 percent from baseline was sufficient to reduce disability.

Swimming, elliptical training, cycling, and upper body exercise may help in such cases. Other nonpharmacologic treatments include bracing and splinting to help support painful or unstable joints. A cane can help reduce the weight load in persons with hip or knee osteoarthritis, but it needs to be properly fitted and used on the side contralateral to the affected joint.

The mainstay of treatment for mild osteoarthritis is acetaminophen. A Cochrane review concluded that acetaminophen is better than placebo for treating mild osteoarthritis, and equal to nonsteroidal anti-inflammatory drugs NSAIDs , but with fewer gastrointestinal adverse effects. The U. Food and Drug Administration recommends no more than 4, mg of acetaminophen per day to avoid liver toxicity. It further cautions patients to be aware of coincident use of other over-the-counter or prescription medications that may contain acetaminophen.

When acetaminophen fails to control symptoms, or if symptoms are moderate to severe, NSAID therapy is recommended. NSAIDs as a class are superior to acetaminophen for treating osteoarthritis. Cyclooxygenase-2 inhibitors, such as celecoxib Celebrex , have an improved safety profile for gastrointestinal adverse effects, 18 but are costly and confer an increased cardiovascular risk.

Montvale, N. Cost to the patient will be higher, depending on prescription filling fee. Opioids are often used to treat pain and are an option for osteoarthritis pain.

Because of the potential for abuse, opioids should be an option only if the patient has not responded to acetaminophen or NSAID therapy, or cannot tolerate them because of adverse effects. Opioids should be prescribed first at low dosages and carefully monitored to evaluate for potential dependence. Opioids also may cause chronic constipation and can place older patients at risk of falls. Intra-articular injections of corticosteroids or hyaluronic acid are another option for treating osteoarthritis.

The use of intra-articular corticosteroids primarily provides short-term relief lasting four to eight weeks. It has proven effectiveness in osteoarthritis of the knee, 21 , 22 but may not be as effective for osteoarthritis of the shoulder 23 or hand. The lidocaine can provide some immediate relief, which confirms that the medication was injected into the correct area.

Patients should be warned of a potential flare-up of symptoms within the first 24 hours, followed by an improvement from baseline at 48 hours. Repeat injections are possible in the same joint, but usual practice is limited to four injections annually.

Intra-articular hyaluronic acid injections, also known as viscosupplementation, are widely used by orthopedic surgeons to treat osteoarthritis of the knee. There has been some debate about the effectiveness of viscosupplementation in earlier studies, most of which were manufacturer-sponsored studies. However, a Cochrane review of 76 clinical trials concluded that viscosupplementation was effective for treating knee osteoarthritis. Table 3 provides a cost comparison of intra-articular injections.

There have been head-to-head trials of corticosteroid injections versus hyaluronic acid. A meta-analysis of knee injections found that corticosteroids had a better short-term response rate and were equal to hyaluronic acid in the intermediate four- to eight-week range, but were inferior to hyaluronic acid after eight weeks from the time of injection. For patients experiencing chronic osteoarthritis pain, hyaluronic acid should be considered.

The technique of injection is the same for either medication. A meta-analysis on the effectiveness of acupuncture for osteoarthritis of the knee found only short-term benefit, which the authors described as clinically irrelevant.

The most widely used supplements for osteoarthritis are glucosamine and chondroitin. The trial had five arms comparing glucosamine alone, chondroitin alone, a combination of glucosamine and chondroitin, celecoxib, and placebo. The results were favorable only for the combination of glucosamine and chondroitin, which appeared to be effective for moderate to severe osteoarthritis of the knee. Balneotherapy is a heterogeneous group of treatments also known as spa therapy or mineral baths.

A Cochrane review concluded that mineral baths were of some benefit to patients with osteoarthritis, but the authors addressed methodologic flaws in the studies and urged caution in interpreting the findings.

It has been found to be superior to placebo in treating osteoarthritis pain. It is widely available, is relatively inexpensive, and can be used as an adjunct to standard osteoarthritis treatments. Surgery should be reserved for patients whose symptoms have not responded to other treatments. The well-accepted indication for surgery is continued pain and disability despite conservative treatment. The most effective surgical intervention is total joint replacement, with excellent patient outcomes following total joint replacement of the hip, knee, and shoulder.

Patients can expect that most current joint prostheses will function well for 15 to 20 years. There are other surgical approaches to osteoarthritis treatment, but they have not equaled the success of total joint replacement. Randomized trials of arthroscopic debridement for osteoarthritis of the knee have consistently failed to show an advantage over maximal medical therapy combined with physical therapy.

A PubMed search using the key word osteoarthritis was performed in March