Osteoarthritis - Treatment 

Exercise

Exercise is one of the most important treatments 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 exercise will make your symptoms worse.

However, regular exercise that keeps you active, builds up muscle and strengthens the joints usually helps to improve symptoms.

Exercise is also good for losing weight, improving your posture and relieving stress, 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's important to follow this plan because there's a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints.

Read more about health and fitness including simple ways to exercise at home.

Losing weight

Being overweight or obese often makes osteoarthritis worse as it can place some of your joints under increased strain.

To find out if you are overweight or obese, use the healthy weight calculator.

If you're 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 about how to lose weight slowly and safely.

Read more information and tips on losing weight.

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• Arthritis Care: exercise and arthritis
• Arthritis Care: diet and arthritis

Your doctor will talk to you about medicines that can control symptoms of osteoarthritis, including painkillers.

Sometimes a combination of therapies – medicines, exercise and assistive devices or surgery – may be needed to help control your pain.

Painkillers

The type of painkiller (analgesic) your GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are described below.

Paracetamol

If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with. This is available over the counter in pharmacies without a prescription. It's best to take it regularly rather than waiting until your pain becomes unbearable.

However, when taking paracetamol, always follow the dosage your GP recommends and don't 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 that work by reducing inflammation. There are two types of NSAID and they work in slightly different ways:

• traditional NSAIDs – such as ibuprofen, naproxen or diclofenac
• 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 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. If you're 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'll 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

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 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 isn't suitable if you have uncontrolled epilepsy, and dihydrocodeine isn't recommended for patients with chronic obstructive pulmonary disease (COPD).

If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.

Capsaicin cream

Your GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs haven't been effective in easing your pain.

Capsaicin cream works by blocking the nerves that send pain messages in the treated area. 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 up to four times a day, but not more often than every four hours. Don't 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's likely to be very painful for a few hours. However, it won't 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. But 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.

Corticosteroid injections

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 joints affected by osteoarthritis. This is known as intra-articular injection.

If you need intra-articular injections, it's likely that you'll have injections of corticosteroid, a medicine that reduces swelling and pain.

If you get a prolonged response to the injection, it may be repeated. Ideally, you should have no more than three corticosteroid injections a year, with at least a three-month gap between injections.

Viscosupplementation

Viscosupplementation may be available as a treatment option for people who have tried all other non-surgical treatments without success.

It involves receiving up to five injections of hyaluronic acid directly into the affected joints over several weeks. Hyaluronic acid is found in the synovial fluid in joints and acts as both a lubricant and shock absorber.

If the injections are successful, the procedure may be repeated around every six months.

There's evidence that viscosupplementation may help to temporarily reduce pain and improve symptoms of osteoarthritis in some people. However, many people may not benefit from the injections and more research is needed about the long-term effects.

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• Arthritis Care: taking medication
• Arthritis Research UK: arthritis drugs

In addition to lifestyle changes and medication, you may also benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) uses a machine that sends electrical impulses through sticky patches, called electrodes, attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.

Treatment with TENS is usually arranged by a physiotherapist, who can advise on the strength of the pulses and how long your treatment should last.

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.

Manual therapy

Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a treatment provided by a physiotherapist. It uses stretching techniques to keep your joints supple and flexible.

Read more about physiotherapy.

Assistive devices

If your osteoarthritis causes mobility problems or difficulty performing everyday tasks, 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 assistive devices in your home or workplace.

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• Arthritis Care: occupational therapy
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• Arthritis Research UK: therapies

Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where one of your joints is severely damaged.

If you 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 can't be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness from your condition.

There are several different types of surgery for osteoarthritis. Some of the main types of surgery carried out are described below.

Arthroplasty

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, although it may eventually need to be replaced.

There's 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.

Read more about hip replacement and knee replacement.

Arthrodesis

If joint replacement isn't suitable for you, your surgeon may suggest an operation known as an arthrodesis, which fuses your joint in a permanent position.

This means your joint will be stronger and much less painful, although you will no longer be able to move it.

Osteotomy

If you have osteoarthritis in your knees but you're not suitable for knee replacement surgery, 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 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.

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Some people with osteoarthritis try complementary or alternative therapies – such as acupuncture and aromatherapy – and find them helpful.

However, there's often a lack of medical evidence to suggest they're effective and they generally aren't recommended by the National Institute for Health and Care Excellence (NICE).

Nutritional supplements

A number of nutritional supplements have also been used to treat osteoarthritis in the past, including chondroitin and glucosamine.

Glucosamine hydrochloride hasn't been shown to have any beneficial effects, but there's evidence that glucosamine sulphate and chondroitin sulphate may help symptoms to a small degree and don't cause many side effects.

However, these supplements can be expensive and NICE recommends that they shouldn't routinely be offered on the NHS.

Rubefacients

Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. Several rubefacients have been used to treat joint pain caused by osteoarthritis.

However, research has shown that rubefacients have little effect in improving the symptoms of osteoarthritis and NICE therefore doesn't recommend their use.

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• Arthritis Research UK: complementary therapies