By Yolanda Smith, BPharm
The effective management of osteoarthritis involves a combination of lifestyle modifications and medical treatment. In severe cases, surgery may also provide a suitable solution.
Lifestyle choices are important to consider when managing osteoarthritic symptoms, particularly as small changes can make a notable difference to the severity of symptoms.
Excess weight is known to aggravate symptoms and being obese is a widely accepted cause of this condition. This is primarily due to the additional pressure that is put on the joints from the extra weight.
As a result, taking measures to lose weight should be included in the management plan of every overweight or obese individual that suffers from osteoarthritis. It has been shown to decrease pain, reduce stiffness and improve joint function, which ultimately leads to less need for pharmaceutical management.
Moderate exercise should also be done at least three times per week for those who with affected knee and hip joints. This has been found to benefit individuals in respect to both pain and function.
Treating symptoms of osteoarthritis with physical and massage therapies may provide beneficial symptoms relief, although the overall effectiveness of these treatments has not been determined.
Functional, gait and balance training are recommended to help improve position sense, balance and strengths. This is particularly useful for those individuals that have lower extremity arthritis, leading to a higher risk of falls in the elderly and resulting fractures.
Knee braces may provide a benefit to users in helping to maintain control and reduce pain. Lateral wedge insoles, however, have not been shown to offer a useful benefit for osteoarthritis.
To help in the relief of stiffness, heat management may prove to offer a benefit, and cold therapy may help to manage muscle spasms and pain.
In general, simple analgesics are the first line choice for the management of the pain associated with osteoarthritis.
Paracetamol is associated with fewer side effects, making it the preferred treatment for mild to moderate pain for this reason. It is often able to offer a suitable form of pain relief and has a good safety profile with long-term use.
NSAIDS such as ibuprofen, aspirin and naproxen may also prove beneficial to aid in pain relief of osteoarthritis, particularly for more severe pain. When NSAIDS are used for extended periods of time, however, they are associated with a higher risk of gastrointestinal complications such as ulcers and cardiovascular risk of stroke and heart attack. As a result, they should be used appropriately and, where possible, steps should be made to manage this risk.
As an example, taking an antacid with an NSAID has been shown to help reduce the risk of gastrointestinal ulceration. Additionally, it is important that patients are aware of the signs of possible complications, such as abdominal pain and black stools. In the case that complications do occur, they will then be more equipped to seek immediate medical attention.
COX-2 selective inhibitors such as celecoxib are another class of NSAIDS that are associated with a lower risk of gastrointestinal effects but increased myocardial infarction risk. As a result, they may prove a good option for individuals that are particularly susceptible to gastrointestinal effects.
As a second line option, oral opioids may offer a solution. The appropriateness of this treatment is not clear and it is only recommended when first line treatments are not suitable for the individual. They have only been shown to offer a small benefit but are associated with comparably more severe side effects.
NSAIDS such as diclofenac can also be formulated into a topical gel to be applied directly to the affected area. This offers the benefit of reduced risk of gastrointestinal effects, although may produce a mild skin reaction in some people.
There are transdermal opioid pain and topical capsaicin medical options available, although the efficacy of these is controversial.
Hydrocortisone injections are able to provide short-term pain relief that may last between a few weeks and a few months. Platelet rich plasma injections may have a role, as they seem to improve joint function, but they have no effect on pain and are also associated with significant risks.
Hyaluronic acid injections are not recommended, as they do not offer substantial improvement but are associated with harmful effects.
The available evidence for the dietary supplements and natural treatments is limited and, as a result, the recommendations for their use are often unclear.
Glucosamine is thought to offer a benefit based on the role it plays in joint cartilage. Although it appears to be safe, it efficacy is controversial and recent trails have not found it to be significantly more beneficial than placebo. It is possible that glucosamine sulfate is more efficacious that glucosamine hydrochloride, although both offer modest benefits. According to the Osteoarthritis Research Society International, glucosamine should be ceased if no effect is observed after six months.
Some other alternative medications that may prove useful include:
- SKI 306X (Chinese herbal medicine)
- Cat’s claw
- Avocado and Soybean
- Boswellia serrate
The following may also be beneficial but are supported by less evidence:
- Ayurvedic herbal preparations (Articulin F and Eazmov)
- Devil’s claw
- Duhuo Jisheng Wan (Chinese herbal medicine)
- Fish liver oil
- Omega-3 Fatty acids
- Stinging nettle
- Vitamins A, C and E
- Vitamin K
- Willow bark
Acupuncture has been associated with a modest relief of pain, although the significance of this is uncertain, as the long-term benefits are small.
Electro stimulation techniques like TENS have been used historically, despite a lack of evidence to demonstrate its efficacy.
For severe cases of osteoarthritis, surgery may provide an alternative solution. Joint arthroplasty surgery or resurfacing can help and joint replacement of knees and hips can be clinically effective. In the long-term, it also offers a cost effective solution.
Osteotomy may help people who suffer from knee osteoarthritis although evidence is limited. Arthroscopic surgery, on the other hand, is not associated with improved outcomes.
Last Updated: Mar 30, 2015