Treatment and Prevention
Treatments include physical therapy to improve mobility and flexibility, medications to manage pain, and surgery.
If you have OA, talk to your physiotherapist or occupational therapist about "aids of daily living" such as canes, walkers, and braces.
Non-prescription medications may be sufficient to treat pain and swelling for milder symptoms, but prescription medications are needed for more severe symptoms. The following are commonly used medications to treat OA:
- acetaminophen* reduces mild to moderate pain
- NSAIDs such as ibuprofen or naproxen reduce both pain and swelling
- topical medications such as diclofenac or capsaicin lotion may be used for very mild pain or in addition to other treatments
- codeine may be considered to treat severe acute (short-term) pain
- cortisone, which is injected directly into the joints, can relieve pain and swelling
- hyaluronic acid injections into joints are used to relieve pain and improve mobility, but there is disagreement about their value
- many large and major studies of chondroitin or glucosamine have failed to show any value to their use, though many patients say that they work
Surgery is an option if one joint is badly damaged or is causing severe symptoms. Different types of surgical options are available and include joint replacement arthroscopy (a procedure where a small, flexible tube is inserted to do surgery), repair of bone deformity, rebuilding of the joint, or bone fusion. Joints that may benefit from surgery include knees, hips, shoulders, and certain joints in the hands and the feet.
For people with hip and knee OA that has progressed to the point of disability, joint replacement surgery is highly effective and a reasonably safe treatment option (essentially at any, even advanced, age). For many people, they are able to return to nearly completely normal activity after recovery from the surgery. The correct timing for joint replacement is when the patient decides that the need outweighs the risk and downtime of the surgery.
Many cases of OA can be prevented. To prevent the development of OA later on in life, maintain a healthy weight. Excess weight can put stress on weight-bearing joints such as knees or hips and increase the wear and tear on the cartilage. Protect your joints from injury. Repeated minor injuries due to constant kneeling, squatting, or other postures that place stress on the knee joint can cause cartilage to break down. Exercise can help reduce joint pain and stiffness. Talk to your physiotherapist or occupational therapist about how low-impact exercise such as bicycling, swimming, or water exercise could be beneficial for you.
Athletes should understand that OA later in life is common for people who have lived a very active and rigorous lifestyle. For most, this risk is probably worth the value they receive from their athletic passion. They should be particularly careful to take immediate care of all injuries, even seemingly minor, and to carefully follow their doctor's advice.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Michael E. Makover, MD, is a professor of medicine at NYU School of Medicine and an Adjunct Professor at NYU College of Arts and Sciences. He is in the private practice of Rheumatology, Internal Medicine and Preventive Medicine in New York, NY. Review provided by VeriMed Healthcare Network.