Osteoarthritis is the most common type of arthritis, especially among older people. An estimated 27 million Americans over age 24 have it. But this degenerative joint disease is manageable. With the right osteoarthritis treatments, you can help ease the daily pain. Learn which 6 therapies are right for you.
Also called degenerative joint disease, osteoarthritis mostly affects cartilage – the hard but slippery tissue that covers the ends of bones where they meet to form a joint.
Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. But in osteoarthritis, the surface layer of cartilage breaks and wears away. This allows bones under the cartilage to rub together, causing pain, swelling and loss of motion in the joint.
Over time, the joint may lose its normal shape. Small deposits of bone – called osteophytes or bone spurs – may grow on the edges. Bits of bone or cartilage can break off and float inside the joint space, causing more pain and damage.
People with osteoarthritis usually have joint pain and stiffness. The most commonly affected joints are those at the ends of the fingers (closest to the nail), thumbs, neck, lower back, knees and hips.
Although osteoarthritis becomes more common with age, younger people can develop it – usually as the result of a joint injury, joint malformation or genetic defect in joint cartilage.
Before age 45, more men than women have it; after age 45, it’s more common in women. It’s more likely to occur in people who are overweight and in those with jobs that stress particular joints.
It may progress quickly, but for most people, joint damage develops gradually over years. Early in the disease, your joints may ache after physical work or exercise. Later on, osteoarthritis symptoms and pain may become more persistent.
You may also experience joint stiffness, particularly when you first wake up in the morning or have been in one position for a long time.
Osteoarthritis symptoms and warning signs include:
Stiffness in a joint after getting out of bed or sitting for a long time
Swelling in one or more joints
A crunching feeling or the sound of bone rubbing on bone
Get treatment for osteoarthritis
Most successful osteoarthritis treatments involve a combination of remedies tailored to the patient’s needs, lifestyle and health, including ways to manage pain and improve function. They include the following:
Exercise
Physical movement is one of the best osteoarthritis treatments. It can improve mood and outlook, decrease pain, increase flexibility, strengthen the heart and improve blood flow, maintain weight, and promote general physical fitness. Your doctor and/or physical therapist can recommend specific types of exercise depending on your particular situation.
The following kinds of exercise are part of a well-rounded osteoarthritis treatment plan.
Strengthening workouts. These exercises strengthen muscles that support joints affected by arthritis. They can be performed with weights or with exercise bands, inexpensive devices that add resistance.
Aerobic activities. These are exercises, such as brisk walking or low-impact aerobics, that get your heart pumping and can keep your lungs and circulatory system in shape.
Range-of-motion activities. These keep your joints limber.
Balance and agility exercises. These help you maintain daily living skills.
Weight control
Osteoarthritis patients who are overweight or obese should try to lose weight through a healthy diet and regular exercise. This can reduce stress on weight-bearing joints, limit further injury and increase mobility.
Rest and joint pain relief
Patients must learn to recognize the body’s signals, and know when to stop or slow down. This will prevent the pain caused by overexertion.
Although your osteoarthritis symptoms can make it more difficult, getting proper sleep is important for managing osteoarthritis pain. If you have trouble sleeping, you may find that relaxation techniques, stress reduction and biofeedback can help, as can timing medications to provide maximum pain relief through the night. If joint pain interferes with your ability to sleep or rest, consult your doctor.
Nondrug pain relief and alternative therapies
People with osteoarthritis may find many drug-free ways to find joint pain relief. Below are some examples:
Heat and cold. Heat can be applied in a number of different ways – with warm towels, hot packs or a warm bath or shower – to increase blood flow and ease pain and stiffness.
In some cases, cold packs (bags of ice or frozen vegetables wrapped in a towel), which reduce inflammation, can relieve pain or numb the sore area.
Transcutaneous electrical nerve stimulation (TENS). This technique uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. It may relieve some arthritis pain by blocking messages to the brain and modifying pain perception.
Massage. As an osteoarthritis treatment, 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 problems of the disease.
Acupuncture. Some people have found pain relief using this practice, in which fine needles are inserted by a licensed acupuncture therapist at specific points on the skin. Scientists think the needles stimulate the release of natural, pain-relieving chemicals produced by the nervous system.
Nutritional supplements. Natural remedies such as glucosamine and chondroitin sulfate have been reported to improve osteoarthritis symptoms, as have certain vitamins (such as vitamin D). But the research is unclear.
Medications to control pain
Doctors consider a number of factors when choosing treatment for osteoarthritis patients.
These include the intensity of pain, potential side effects of the medication, your medical history (other health problems you have or are at risk for), and other medications you’re taking.
Because some medications can interact with one another and certain health conditions put you at increased risk of side effects, it's important to discuss your medication and health history with your doctor before you start taking any new drug.
You should learn as much as possible about the medications you take, even the ones available without a prescription.
The following types of medicines are commonly used in treatment for osteoarthritis:
Acetaminophen: Available without a prescription, acetaminophen (Tylenol) is often the first medication doctors recommend for osteoarthritis patients.
(For information on potential risks, see Pain Medications: Could You Be Overdosing?)
NSAIDs (nonsteroidal anti-inflammatory drugs): A large class of medications useful against both pain and inflammation, NSAIDs such as aspirin, ibuprofen, naproxen and naproxen sodium are also frequently taken as osteoarthritis treatments.
They work by blocking substances called prostaglandins, which contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body. For unknown reasons, some people seem to respond better to one NSAID than another.
Some NSAIDs are available over the counter, while more than a dozen others, including a subclass called COX-2 inhibitors, are available only with a prescription.
All NSAIDs can have significant side effects, including stomach irritation and other gastrointestinal problems. Any person taking NSAIDs regularly should be monitored by a doctor.
Narcotic or central-acting agents. Tramadol is a prescription pain reliever and synthetic opioid that works through the central nervous system; it’s sometimes prescribed when over-the-counter medications don’t provide sufficient relief for osteoarthritis symptoms. It carries risks that don’t exist with acetaminophen and NSAIDs, including the potential for addiction.
Mild narcotic painkillers containing 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. These are powerful anti-inflammatory hormones that may be injected into the affected joints to temporarily relieve osteoarthritis pain. This is a short-term measure, generally not recommended for more than 2-4 treatments per year.
Hyaluronic acid substitutes. Sometimes called viscosupplements, these are designed to replace a normal component of joint lubrication. They’re injected into the joint, and are only approved for osteoarthritis of the knee.
Topical medications. Doctors may prescribe pain-relieving creams, rubs and sprays, which are applied directly to the skin over painful joints.
Surgery
For many people, surgery helps relieve the pain and disability of osteoarthritis. It may 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 (arthroscopy)
Repositioning of bones (osteotomy)
Resurfacing (smoothing out) bones
Surgeons may replace affected joints with artificial joints called prostheses.
These can be made from metal alloys, high-density plastic or 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 (a process called biologic fixation) to hold them in place.
Joint replacement advances in recent years have included the ability, in some cases, to replace only the damaged part of the knee joint, leaving undamaged parts of the joint intact, and the ability to perform hip replacement through much smaller incisions than previously possible.
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.
Artificial joints to provide joint pain relief can last 10-15 years or longer.
Excerpted from “Handout on Health: Osteoarthritis” by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health.
For more on relieving joint pain, visit our Osteoarthritis Health Center .
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