Osteoarthritis can be managed by improving your general health. Your doctor may recommend ways you can help yourself, such as taking regular exercise and losing weight.
Exercise is the most important treatment for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.
If osteoarthritis causes you pain and stiffness, you may think that exercise will make your symptoms worse. But usually, regular exercise that keeps you active and mobile and builds up muscle, thereby strengthening the joints, will improve symptoms. Exercise is also good for relieving stress, losing weight and improving your posture, all of which will ease symptoms.
Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from your exercise programme and can give you an exercise plan to follow at home. It is important to follow this plan because there is a small risk that the wrong sort of exercise may damage your joints.
Being overweight or obese makes osteoarthritis worse. The extra weight puts more strain on damaged joints, which have a reduced ability to repair themselves. Joints in the lower limbs, which carry your weight, are under particular stress if you are overweight or obese.
If you are overweight, try to lose weight by doing more physical activity and eating a healthier diet. Discuss any new exercise plan with your GP or physiotherapist before you start. They can help plan a suitable exercise programme for you. Your GP and practice nurse can also advise you about how to lose weight slowly and safely.
Medicines for osteoarthritis
Your doctor will talk to you about medicines to help control the symptoms of osteoarthritis, including painkillers. Often a combination of therapies, including medicines, devices or surgery, may be needed.
The type of painkiller (analgesic) your GP may recommend for you will depend on the severity of your pain and any other conditions or health problems you have.
If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter (OTC) in pharmacies without a prescription. It is best to take it regularly rather than waiting until your pain becomes unbearable.
However, when taking paracetamol, always follow the dosage that your GP recommends and do not exceed the maximum dose stated on the pack.
Non-steroidal anti-inflammatory drugs (NSAIDs)
If paracetamol does not effectively control the pain of your osteoarthritis, your GP may prescribe a stronger painkiller. This may be a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are painkillers which work by reducing inflammation. There are two types of NSAID and they work in slightly different ways. These are traditional NSAIDs (such as ibuprofen, naproxen or diclofenac) and COX-2 inhibitors, often called coxibs (such as celecoxib and etoricoxib).
Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available over the counter (OTC) without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.
Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it. NSAID tablets may not be suitable for people with certain conditions, such as asthma, a peptic ulcer or angina, or if you have had a heart attack or stroke. Do not take over-the-counter ibuprofen if you have had any of these conditions. If you are taking low-dose aspirin, ask your GP whether you should use an NSAID.
If your GP recommends or prescribes an NSAID to be taken by mouth, they will usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining. COX-2 drugs have a lower risk of causing stomach problems, but still need to be used with a PPI if you take them regularly.
Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but they can also cause side effects such as drowsiness, nausea and constipation.
Codeine is found in combination with paracetamol in common preparations such as co-codamol. Other opioids that may be prescribed for osteoarthritis include tramadol (brand names include Zamadol and Zydol), and dihydrocodeine (brand name DF 118 Forte). Both come in tablet form and as an injection. Tramadol is not suitable if you have epilepsy, and dihydrocodeine is not recommended for patients with chronic obstructive pulmonary disease (COPD). Pregnant women should not take any opioids.
If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to treat any constipation.
If you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain, your GP may prescribe capsaicin cream.
Capsaicin cream works by blocking the nerves that send pain messages. You may have to use it for a while before it has an effect. You should experience some pain relief within the first two weeks of using the cream, but it may take up to a month for the treatment to be fully effective.
Apply a pea-sized amount of capsaicin cream to your affected joints four times a day, but not more often than every four hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.
Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it is likely to be very painful for a few hours. However, it will not cause any damage.
You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. However, avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.
If your osteoarthritis is severe, treatment using painkillers may not be enough to control your pain. In this case, you may be able to have a type of treatment where medicine is injected into the parts of your body that are affected by osteoarthritis. This is known as intra-articular treatment and is injected inside your affected joints.
If you need to have intra-articular injections, it is likely that you will have injections of corticosteroid, a medicine that reduces swelling and pain. However, the National Institute for Health and Clinical Excellence (NICE) does not recommend intra-articular injections of hyaluronic acid for osteoarthritis.
If you get a prolonged response to the injection, it may be repeated. If you do not respond to the injection, or have a joint like the hip, which needs a guided injection, then your doctor can refer you for a guided injection.
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) uses a machine that may help ease the pain caused by your osteoarthritis. It works by numbing the nerve endings in your spinal cord which control pain, so you can no longer feel it.
Treatment with TENS is usually arranged by a physiotherapist. Small electrical pads (electrodes) are applied to the skin over your affected joint. These deliver small pulses of electricity from the TENS machine. Your physiotherapist can advise on the strength of the pulses and how long your treatment lasts.
Hot or cold packs
Applying hot or cold packs (sometimes called thermotherapy or cryotherapy) to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain. Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.
Not using your joints can cause your muscles to waste and may worsen stiffness caused by osteoarthritis. Manual therapy is a treatment provided by a physiotherapist. It uses stretching techniques to keep your joints supple and flexible.
If your osteoarthritis causes mobility problems or if performing everyday tasks is difficult, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.
If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes. Footwear with shock-absorbing soles can help relieve some of the pressure on the joints of your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.
If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.
A splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.
If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks far more manageable. Your occupational therapist can give you help and advice about using these devices in your home or workplace.
Surgery for osteoarthritis is only needed in a small number of cases. It can sometimes be helpful for osteoarthritis that affects your hips, knees or joints, particularly those at the base of your thumb. Your GP may suggest surgery if other treatments have not been effective, or if one of your joints is severely damaged.
If you may need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon.
Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life. However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness due to your condition.
There are several different types of surgery for osteoarthritis. You may have surgery to smooth the surfaces of your joints or restore cartilage (arthroscopy). Or you may have surgery to replace your whole joint, the weight-bearing surface (resurfacing), or to fuse it into position.
Joint replacement therapy, also known as an arthroplasty, is most commonly carried out to replace hip and knee joints.
During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years. However, it may eventually need to be replaced.
There is also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.
If joint replacement is not suitable for you, your surgeon may suggest an operation known as an arthrodesis, which fuses your joint in a permanent position. This means that your joint will be stronger and much less painful, although you will no longer be able to move it.
If you have osteoarthritis in your knees but you are too young for knee replacement surgery (arthroplasty), you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.
This helps realign your knee so that your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve your symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
Complementary and alternative therapies
Many people with osteoarthritis try complementary and alternative therapies. There is evidence that some of these may help symptoms, but experts disagree whether they slow down progress of the disease.
Acupuncture, aromatherapy and massage are some commonly used complementary therapies for osteoarthritis. Some people may find that they help, although they can be expensive and time consuming.
A number of nutritional supplements are available for treating osteoarthritis. Two of the most common supplements for osteoarthritis are chondroitin and glucosamine.
Glucosamine hydrochloride has not been shown to have any beneficial effects, but there is some evidence that glucosamine sulphate and chondroitin sulphate help symptoms and do not cause many side effects. These supplements can be expensive. The National Institute for Health and Clinical Excellence (NICE) has recommended that chondroitin or glucosamine should not be prescribed, but patients often choose to take them as over the counter preparations.
Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. Several rubefacients can be used to treat joint pain caused by osteoarthritis.
Research has shown that rubefacients have little or no effect in treating osteoarthritis, so their use cannot be recommended