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How is osteoarthritis treated?

Medication for osteoarthritis (degenerative joint disease) works best with other pain relief strategies, such as exercising to build your muscles and protecting your joints from injury or overuse. Options include the following:

  • Topical pain relievers, which are applied to the skin, offer one alternative for mild pain relief. Creams containing salicylate, such as Aspercreme or Bengay, and others containing capsaicin, such as Zostrix, are available over the counter.
  • Oral drugs. Doctors often recommend acetaminophen (Tylenol) first because it's effective for mild pain and easy on the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally considered more effective than acetaminophen in treating osteoarthritis because they reduce inflammation as well as pain. The arsenal of NSAIDs includes over-the-counter medications such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve) as well as prescription drugs diclofenac (Voltaren), indomethacin (Indocin), meloxicam (Mobic) and nabumetone (Relafen). Because the NSAIDs, particularly aspirin and indomethacin, inhibit the enzyme that protects the stomach lining and interfere with blood clotting, they increase the risks of bleeding and gastric ulcers. Some of the prescription NSAIDs, particularly nabumetone, meloxicam and diclofenac, seem to be relatively gentler on the digestive system. Some formulations, such as Arthrotec or Prevacid NapraPAC, combine an NSAID with a medication that protects the stomach.
  • Glucosamine and chondroitin. These supplements shouldn't hurt you, but their effectiveness is still under study. As always, if you choose to take these or any other alternative preparations, be sure to inform your physician.
  • Injections. Corticosteroid injections into the joint can relieve inflammation quickly, but usually only for a short time. They are recommended no more than two to three times a year, and only when absolutely necessary, because these drugs may increase the risk of infection and can further damage the joints. Another alternative, hyaluronate (Hyalgan, Synvisc), is a synthetic version of a natural lubricant in the joint. It can be injected directly into the knee at weekly intervals for three to five weeks. However, the modest benefits experienced by some patients may not be worth the discomfort of the injections.
Dr. Scott D. Martin, MD
Orthopedic Surgeon

For osteoarthritis pain relief, over-the-counter pain relievers, including acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be effective. A combination of pain relievers, such as acetaminophen and ibuprofen, may bring more relief than using one of these medications alone. Do not exceed recommended dosages. Pain relievers have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering the regular use of these medications. Occasionally, a doctor may inject a long-acting corticosteroid drug into a joint, often combined with a local anesthetic, to ease pain. However, repeated injections may speed degeneration of cartilage.

Dr. Geraldine M. Navarro, MD
Rheumatologist

Some of the medications that are prescribed to relieve osteoarthritis (OA) are Tylenol, which has fewer side effects than other medications, and nonsteroidal anti-inflammatories (NSAIDs), though they can cause more side effects. Sometimes, doctors inject steroids into the joint to decrease the amount of inflammation. If that doesn’t work, doctors can inject hyaluronic acid.

Donna Hill Howes, RN
Family Practitioner

You and your doctor can work together to manage your osteoarthritis pain. A variety of treatments are available. Your doctor will help plan the best individualized treatment for you. This could include one or more of the following:

  • taking acetaminophen (Tylenol)
  • using topical capsaicin cream
  • aspirating swollen joints if needed, which is done in a doctor's office
  • injecting a corticosteroid such as betamethasone (Celestone Soluspan), which also is done in a doctor's office
  • taking low-dose nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen 400 milligrams (mg) or naproxen 200-250 mg
  • taking higher-dose prescription strength NSAIDs, such as ibuprofen 600-800 mg three times a day, naproxen 500-550 mg twice a day, misoprostol (Cytotec), or an NSAID COX-2 inhibitor such as celecoxib (Celebrex)
  • injecting hyaluronic acid directly into the joint to aid with cushioning (Synvisc)
  • undergoing surgery or joint replacement

Osteoarthritis is treatable, in many cases by exercise and a healthy diet—things we should be doing anyway for optimum health. Treatment usually involves a combination of therapies. The management options for osteoarthritis include the following:

  • Maintaining a healthy weight
  • Exercising regularly
  • Talking to your doctor about medications that ease pain
  • Trying non-medication options
  • Resting when needed
  • For severe cases, exploring surgical options
Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

No matter what your political persuasion may be, conservative is the way to go when it comes to treating osteoarthritis. If you have mild joint pain and stiffness, try using ice packs or a heating pad, whichever works best for you, for relief. Losing a little weight and getting regular exercise (such as walking or swimming) can help too.

However, for many people with osteoarthritis, lifestyle changes aren't enough to manage their daily discomfort. Medication is a mainstay of treatment for osteoarthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most commonly used drugs for chronic joint pain. Acetaminophen is another option. You can also try medicinal herbs and other dietary supplements, though you should only do so after telling your doctor. Keep in mind, too, that the scientific evidence for many of these products is incomplete. If none of these over-the-counter medications bring you pain relief, your doctor may prescribe stronger medicine.

Other, more-conservative treatment options include physical therapy. If your pain persists, your doctor will likely recommend surgery to repair the damage or replace your worn-out joint with an artificial implant.

Osteoarthritis treatment options include analgesics and anti-inflammatory drugs, more natural supplements like chondroitin and injections. Watch rheumatologist Natalie Azar, MD, describe the various treatment options for osteoarthritis pain.

Treatments for osteoarthritis aim to control pain, to improve the ability to work, to perform everyday tasks and to maintain quality of life. Currently, there are no treatments that can dependably stop or cure osteoarthritis. Increasingly, treatment has included other goals—namely, to stop and to reverse the biochemical processes of osteoarthritis and to stop the disease from progressing.

In the meantime, there are many treatment options for controlling pain and improving function. The treatments that are the most appropriate for you depend on the joints that are involved, the severity of joint pain, the impairment of joint function and other conditions that you may have.

The treatments and management tools for osteoarthritis can be organized as a pyramid. At the base of the pyramid are the most important approaches and those that are useful for the greatest number of people with the condition. At the top of the pyramid are treatments that are used only in the most severe or unusual cases.

As the severity of osteoarthritis increases, treatments progress, step by step, up the pyramid.

 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.