Osteoarthritis: Treatment

Most successful treatment programs involve a combination of treatments tailored to the patient's needs, lifestyle, and health. Most programs include ways to manage pain and improve function. Major components of treatment include the following:

Exercise

Research shows that exercise is one of the best treatments for osteoarthritis. Exercise can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow. Exercise can also assist in maintaining weight and promoting general physical fitness. It is inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise prescribed will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done. Walking, swimming, and water aerobics are a few popular types of exercise for people with osteoarthritis. Your doctor and/or physical therapist can recommend specific types of exercise depending on your particular situation.

Weight Control

Osteoarthritis patients who are overweight or obese should try to lose weight. Weight loss can reduce stress on weight-bearing joints, limit further injury, and increase mobility. A dietitian can help you develop healthy eating habits. Proper diet and regular exercise are critical for achieving a healthy weight.

Rest and Relief from Stress on Joints

Patients must learn to recognize the body's signals and know when to stop or slow down. This will prevent any pain caused by overexertion. Although pain can make it difficult to sleep, getting proper sleep is important for managing arthritis pain. If you have trouble sleeping, you may find that relaxation techniques, stress reduction, and biofeedback can help. Try to time medications to provide maximum pain relief through the night.

Some people use canes to take pressure off painful joints. They may use splints or braces to provide extra support for joints and/or keep them in proper position during sleep or activity. Splints should be used only for limited periods of time because joints and muscles need to be exercised to prevent stiffness and weakness. If you need a splint, an occupational therapist or a doctor can help you get a properly fitted one.

Non-Drug Pain Relief

Individuals with osteoarthritis have many options when it comes to nondrug treatment. Some of these include:

• Heat and cold: Heat or cold (or a combination of the two) can be useful for joint pain. Heat applied in any of a variety of ways-such as with warm towels, hot packs, or a warm bath or shower-can increase blood flow and ease pain and stiffness. In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel) can reduce inflammation and relieve pain or numb the sore area.

• Transcutaneous electrical nerve stimulation (TENS): TENS is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.

• Massage: In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the condition.

Medication

Doctors prescribe medicines to eliminate or reduce pain and to improve functioning. A variety of factors are taken into consideration when choosing medicines for patients with osteoarthritis. Such factors include pain intensity, potential side effects of the medication, medical history, and other medications being taken.

The following types of medicines are commonly used in treating osteoarthritis:

• Acetaminophen: A medication commonly used to relieve pain, acetaminophen is available without a prescription. It is often the first medication doctors recommend for osteoarthritis patients because of its safety relative to some other drugs and its effectiveness against pain.

• NSAIDs (nonsteroidal anti-inflammatory drugs): Aspirin, ibuprofen, naproxen, and naproxen sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body. Some NSAIDS are available over the counter, while others are available only with a prescription. All NSAIDS can have significant side effects.

• Topical pain-relieving creams, rubs, and sprays: These products, which are applied directly to the skin over painful joints, contain ingredients that work in one of three different ways: by stimulating the nerve endings to distract the brain's attention from the joint pain; by depleting the amount of a neurotransmitter called substance P that sends pain messages to the brain; or by blocking chemicals called prostaglandins that cause pain and inflammation.

• Mild narcotic painkillers: Medications containing narcotic analgesics such as codeine or hydrocodone are often effective against osteoarthritis pain. But because of concerns about the potential for physical and psychological dependence on these drugs, doctors generally reserve them for short-term use.

• Corticosteroids: Corticosteroids are powerful anti-inflammatory hormones made naturally in the body or man-made for use as medicine. They may be injected into the affected joints to temporarily relieve pain. This is a short-term measure, generally not recommended for more than two to four treatments per year. Oral corticosteroids are not routinely used to treat osteoarthritis. They are occasionally used for inflammatory flares.

• Hyaluronic acid substitutes: Sometimes called viscosupplements, these products are designed to replace a normal component of the joint involved in joint lubrication and nutrition. Depending on the particular product your doctor prescribes, it will be given in a series of three to five injections. These products are approved only for osteoarthritis of the knee.

Because most medicines used to treat osteoarthritis have side effects, it's important to learn as much as possible about the medications you take, even the ones available without a prescription. Certain health problems and lifestyle habits can increase the risk of side effects of many medications, such as smoking and alcohol use. Make sure to consult your doctor about specific medication recommendations and ways to minimize side effects.

Surgery

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following:

• removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking

• repositioning of bones

• resurfacing (smoothing out) of bones.

Surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. Some prostheses are joined to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone into that surface to hold them in place. Artificial joints can last 10 to 15 years or longer.

The decision to use surgery depends on several factors, including the patient's age, occupation, level of disability, pain intensity, and the degree to which arthritis interferes with his or her lifestyle. After surgery and rehabilitation, the patient usually feels less pain and swelling, and can move more easily.

Complementary and Alternative Therapies

When conventional medical treatment doesn't provide sufficient pain relief, people are more likely to try complementary and alternative therapies. The following are some alternative therapies used to treat osteoarthritis:

• Acupuncture: Some people have found pain relief using acupuncture, a practice in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some patients. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.

• Nutritional supplements: Nutrients such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. Additional studies have been carried out to further evaluate these claims.