What are The Treatments for Osteoarthritis?

If your fingers, hips, knees, or other joints feel painful when you use them, you could have osteoarthritis (sometimes just called arthritis, or OA). It’s a swelling of your joints brought on by wear and tear over many years. The cartilage (a rubbery tissue covering the ends of your bones) breaks down over time, leaving your bones without anything to cushion them. This causes them to rub against each other. Your joints can become inflamed. It can be very painful.

There’s no cure for OA, but there are a lot of treatment options you can try.

Physical Activity

Even though you may not feel like doing it, exercise is the best thing you can do to relieve arthritis pain and lessen joint damage. Exercise can also help you lose weight. That will put less stress on your joints. You should try to get exercise in these three categories:

Stretching. These are exercises to increase your flexibility and range of motion and lubricate your joints. Your doctor may prescribe specific stretching exercises. Yoga, Pilates, and Tai Chi classes are other good ways to get your stretching in. Tell the instructor about your OA so they can make it a safe, enjoyable experience for you.

Strength training. This will build muscle and can protect your joints from injury. Exercises could involve lifting weights or simply using your own body weight (like doing push-ups or sit-ups).

Aerobics. These exercises will strengthen your heart and lungs, cut down on fatigue, and increase your stamina. You will also burn a lot of calories. Typical aerobic exercises include walking, running, riding a bicycle, swimming, or using a treadmill.

The Arthritis Foundation says the two best exercises for people with arthritis are walking and water aerobics. Both are easy on the joints and good for those who are overweight or just starting to exercise. They improve heart health and physical conditioning. You don't need to know how to swim to do water aerobics. They’re done in a swimming pool in shoulder-height water.

Lose Weight

Obesity can cause arthritis. It puts a lot of stress on your hips, back, and knees. But even if you're only moderately overweight, you’ll still benefit if you shed some pounds.

Medicine

Over-the-counter (OTC) medications. A number of medications are good for arthritis pain. Talk with your doctor before starting any of them and be sure they know if you’re taking them regularly.

Common OTC medications are aspirin, ibuprofen, and naproxen. These are called nonsteroidal anti-inflammatory drugs (NSAIDs). They can cause stomach irritation and gastrointestinal bleeding in some people.

Medications with acetaminophen relieve mild to moderate pain and cause few side effects in most people. But large doses can damage your liver. So it's important to follow the instructions carefully.

Prescription medications. Narcotics like Norco, OxyContin, Percocet, Ultram, and Vicodin contain ingredients such as codeine, oxycodone, and hydrocodone. They reduce the pain signals in your body, as well as your brain's reaction to those signals. Side effects can include constipation, nausea, and drowsiness. Short- term use is preferred over long-term use. If you take them regularly, your body can develop a higher tolerance to these medications over time.

Prescription NSAIDs include celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin), naproxen (Anaprox, Naprosyn), piroxicam (Feldene), and sulindac (Clinoril). They are generally safe for most people. But in some people, they can cause stomach bleeding and raise the risk of a heart attack or stroke. Your doctor may want to keep an eye on you while you take prescription NSAIDs.

Corticosteroid injection. This is normally only given if the pain is very severe. Corticosteroids can ease inflammation and swelling and offer quick, short-term pain relief for people with OA. The benefit usually lasts several weeks to several months. Some people can get pain relief for 6 months or longer. These injections are usually given no more than three or four times a year in a single joint. The risk of side effects is small but can include damage to tendons, bleeding, color changes in the skin, and infection.

Hyaluronic acid (HA) injection. This is found in the natural synovial fluid in joints. It helps to lubricate joints and serves as a shock absorber. But natural amounts of HA are lower in people with osteoarthritis. When HA is injected into a joint, it may help lubricate the joint and increase mobility. Injected forms of HA include Euflexxa, Hyalgan, Orthovisc, Supartz, and Synvisc. Hyaluronic acid injections may help ease pain from osteoarthritis of the knee. It isn't clear if it helps other joints. Side effects can include swelling in the joint and a temporary increase in pain.

Antidepressants. Your doctor may recommend an antidepressant to help ease chronic pain. In some people, antidepressants can cause thoughts of suicide or agitation and restlessness. Typically, these medications are started at low doses and slowly increased. It's important to work with your doctor to taper off these drugs over time if you want to stop taking them.

Topical pain relievers. Some creams, ointments, or gels can relieve mild pain on joints that hurt. Use them on your skin over the joint while taking pain relievers for general aching and stiffness.

• Capsaicin (Capzasin, Zostrix) is found in cayenne peppers. It interferes with the release of a substance in your body that helps you feel pain.
• Salicylates (Aspercreme, Bengay) have a substance similar to that found in aspirin. They may stimulate or irritate nerve endings, distracting your brain away from pain.
• Menthol (Icy Hot, Biofreeze) is a counterirritant. It creates a hot or cold sensation that draws your attention away from pain.

Natural Remedies

Some herbs and supplements (capsaicin, flaxseed, ginger, ginkgo, and turmeric) are said to be good for arthritis. But the most popular ones for pain relief are chondroitin sulfate and glucosamine. Both are made of compounds found in cartilage. That’s the tough, flexible tissue that covers the ends of your bones at the joints. When osteoarthritis wears your cartilage down, taking glucosamine is thought to protect what's left. They may help your body regenerate the cartilage on your joints, but evidence remains sketchy.

Studies have shown that they may provide modest pain relief and could be tried if you are unable to tolerate other pain medications. The American College of Rheumatology doesn’t currently recommend the use of chondroitin sulfate and glucosamine.

Other natural remedies include acupuncture, massage, heating pads, and ice packs. Reducing stress by maintaining a positive outlook may also help.

Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) is often used to treat OA. It uses electrodes to send electrical impulses to nerve pathways. This lessens some types of pain.

There's also neuromuscular electrical stimulation (NMES). Instead of just stimulating the nerves, NMES includes the muscle tissue that supports the joint, as well. Studies show it’s an effective treatment, especially for those with OA of the knee.

Visualization

Can you think your way to less stiffness? Many believe that the strong connection between your mind and body can change the way you feel. In creative visualization, or guided imagery, you imagine a pain-free body. When you feel the emotions that come with those images, they have a better chance of happening in real life. Professional athletes, astronauts, and hospitals across the country use creative visualization. It can also reduce the stress and depression that comes with chronic pain.

Magnets and Copper Bracelets

Healing magnets may seem like an attractive option. They're inexpensive, they’re easy to use, and they have no side effects. Believers in this therapy think the magnets help iron circulate in the blood and get joints the nutrition they need. But unlike its metal form, the iron in your body isn't magnetic. Wearing magnets has no physical effect on your blood or joints.

The same goes for copper bracelets. In your body, copper helps make red blood cells and aids in forming the collagen in bones and connective tissue. But copper bracelets don't transfer copper to the body. And adding more of the mineral won't ease joint inflammation.

Fish Oil

If you've heard good things about fish oil, check with your doctor before trying it. It’s rich in omega-3 fatty acids that can help with joint pain or tenderness. But it can be hard on your stomach. Some versions of this supplement may contain toxic amounts of mercury or vitamin A, as well.

ASU

In Europe, a supplement called avocado-soybean unsaponifiables (ASU) has had some success. Made from avocado oil and soybean oil, it's thought to keep OA from progressing as quickly.

Physical Therapy

Physical therapists can work with you on exercises to make the muscles around your joint stronger, reduce pain, and improve your range of motion. They can also help fit you with braces to support your joints or suggest shoe inserts that can also help to take the pressure off.

An occupational therapist (OT) gives you new ways to do everyday tasks, like how to hold your toothbrush or how to shower, without stressing your joints. They can also recommend products, like a shower bench, to lessen flare-ups at home.

If you need additional help, scooters, walkers, and canes may be recommended to help you get around. Tools like jar openers and steering wheel grips can help you manage day-to-day life more easily when you have trouble gripping things. Your therapist can give you advice on how to use them.

Surgery

If you've tried a number of remedies and got no relief or only a temporary reprieve, your doctor may suggest surgery. They'll talk with you about what makes sense for your situation. These procedures can relieve pain and allow for better mobility.

• Arthroscopic surgery. This is a common outpatient procedure for knees and shoulders. Doctors can repair the surfaces of damaged joints, removing loose cartilage, repairing cartilage tears, and smoothing bone surfaces.
• Joint replacement surgery. When nothing else has worked, damaged joints can be replaced with artificial joints. Hips and knees are most the most common, but artificial joints are also available for shoulders, fingers, elbows, and back joints.
• Osteotomy. When someone is too young for joint replacement, this procedure can increase stability in knees or hip joints. It involves cutting bone to redistribute weight on a joint and make it more stable.
• Joint fusion. Also called arthrodesis, this surgery involves fusing two bones on each end of a joint, getting rid of the joint itself. It’s used when joints are severely damaged and cause severe pain. It’s also done when joint replacement is not effective, as with the ankle. Though a fused joint is not flexible, it is more stable, can bear weight better, and will no longer cause pain due to osteoarthritis.

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