Treatment for Osteoarthritis
In most cases, the goals of osteoarthritis treatment are to control symptoms, improve joint function, and slow progression of the disease. Treatment plans often involve lifestyle modifications (e.g., weight loss, exercise), physical therapy, and medication. Severe joint damage caused by osteoarthritis may require surgery.
The application of heat or ice to the affected joint may be helpful, in some cases. Topical analgesics (e.g., creams or rubs), which are available without a prescription, may be applied directly to the affected joint to help relieve pain. Topical analgesics should not be used in combination with heat therapy, because of an increased risk for serious burns.
Over-the-counter and prescription medications may be used to relieve pain and stiffness caused by osteoarthritis. Analgesics (e.g., acetaminophen [Tylenol], which reduce pain, and nonsteroidal anti-inflammatories (NSAIDs; e.g., aspirin, ibuprofen [Advil]), which reduce pain and inflammation (swelling), are commonly used.
These medications can cause serious side effects (e.g., abdominal pain and bleeding, kidney and liver damage) and they should only be taken as directed. Patients who are age 65 or older, those who regularly use alcohol or tobacco, and those who have a previous history of ulcers are at increased risk for significant side effects.
Prescription medications, such as COX-2 inhibitors (e.g., celecoxib [Celebrex]), may be used to treat severe pain that does not respond to other medications. These drugs carry an increased risk for severe cardiovascular side effects, including heart attack and stroke.
In October 2007, the Food and Drug Administration (FDA) approved diclofenac sodium topical gel (Voltaren Gel) to treat osteoarthritis of the knees and hands. Voltaren Gel is a topical nonsteroidal anti-inflammatory drug that can be applied to the affected area four times per day to reduce pain and inflammation.
This drug should only be used as directed and can cause serious side effects similar to other NSAIDs (e.g., gastrointestinal bleeding, heart attack, stroke). Voltaren Gel also can cause skin reactions at the application site. This medication is not approved to treat osteoarthritis of the spine, hip, or shoulder, and should not be used in patients who have a history of asthma or hypersensitivity to NSAIDs. It should be used with caution in elderly patients.
Injectable corticosteroids may be used to treat moderate-to-severe pain. These injections, which are administered directly into the affected joint, often provide effective pain relief that lasts for months at a time.
Types of surgery that may be performed include arthroscopy and arthroplasty (joint replacement). Arthroscopic surgery, which often is performed on the knee or shoulder, involves inserting a thin tube into the joint through a small incision. This tube, which has a tiny camera and light attached, allows the physician to remove tissue for examination and loose cartilage, repair tears in cartilage, and smooth rough bone surfaces.
Joint replacement surgery involves the reconstruction or replacement of a joint, commonly the hip or knee. This procedure usually is performed in patients who have severe disease and are over the age of 50. Following surgery, the new joint (which is comprised of man-made components) usually lasts 20 to 30 years.
Osteoarthritis cannot be prevented in every case. To reduce the risk for developing the condition, overuse of the joints should be avoided and a healthy weight should be maintained.