Osteoarthritis - Treatment and support

There's no cure for osteoarthritis, but the condition does not necessarily worsen over time. There are several treatments to help relieve the symptoms.

The main treatments for the symptoms of osteoarthritis include:

• lifestyle measures – such as maintaining a healthy weight and exercising regularly
• medication?– to relieve your pain
• supportive therapies?–?to help make everyday activities easier

Surgery to repair, strengthen or replace damaged joints may also be considered in a few cases where other treatments have not been helpful.

Lifestyle changes

Exercise

Exercise is one of the most important treatments for people with osteoarthritis, whatever their age or level of fitness. Your physical activity should include exercises to strengthen your muscles and practices to improve your general wellness.

If osteoarthritis causes you pain and stiffness, you may think exercise will worsen your symptoms.

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

Exercise is also suitable for?losing weight, improving your posture and?relieving stress, all of which ease symptoms.

Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from an exercise programme and can give you an exercise plan to follow at home.

It's essential 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.

Losing weight

Being overweight or?obese?often makes osteoarthritis worse, as it places extra strain on some of your joints.

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

If you're overweight or obese, try to lose weight by doing more physical activity and eating a healthier diet.

Before you start, discuss any new exercise plan with your GP or physiotherapist. They can help you plan a suitable exercise programme for you. Your GP and practice nurse can also advise you to lose weight slowly and safely.

Pain relief medicines

Your doctor will talk to you about medicines?to relieve pain from osteoarthritis.

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

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

Paracetamol

If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol, to begin with. You can buy this at supermarkets or pharmacies. It's best to take it regularly rather than wait until your pain becomes unbearable.

When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum amount stated on the pack.

Non-steroidal anti-inflammatory drugs?(NSAIDs)

A GP may prescribe a non-steroidal anti-inflammatory drug (NSAID) if paracetamol does not effectively control osteoarthritis pain.

NSAIDs are painkillers that work by reducing inflammation.

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 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 its benefits and risks.

If paracetamol and topical NSAIDs are not easing the pain, NSAID tablets may be needed. They may not be suitable for people with certain conditions, such as?asthma, a?stomach 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 of your stomach, protecting it against stomach acid. PPIs reduce the amount of acid the stomach produces, reducing the risk of damage to your stomach lining.

Opioids

Opioids, such as codeine, are another 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 combined with paracetamol in common medicines such as?co-codamol.

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

Capsaicin cream

A GP may prescribe capsaicin cream if osteoarthritis in your hands or knees and topical NSAIDs do not effectively ease 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 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 4 times a day, but only sometimes every 4 hours. Do not use capsaicin cream on broken or inflamed skin; always wash your hands after applying it.

Be careful not to get 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 will not cause any damage.

You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about; 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 worsen the burning sensation.

Steroid injections

Steroids?are a type of medication that contain manmade versions of the hormone cortisol and are sometimes used to treat severe musculoskeletal problems.

Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked.

The injection will be made directly into the affected area. You may first be given a local anaesthetic to numb the area and reduce the pain.

Steroid injections?work quickly and can ease the pain for several weeks or months.

Supportive treatments

In addition to lifestyle changes and medicines, you may benefit from several 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 osteoarthritis by numbing the nerve endings in your spinal cord, which controls pain.

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

Hot or cold packs

Applying hot or cold packs to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with hot or cold water and applied to the affected area can effectively reduce pain.

Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available and work similarly.

Assistive devices

If osteoarthritis is causing mobility problems or making it difficult to do 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 in 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 osteoarthritis in your hip or knee 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 rigid material used to support a joint or bone) can also be helpful if you need to rest a painful joint. Your physiotherapist can provide a splint and advise you on using 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 more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace.

Manual therapy

Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep your joints supple and flexible.

Surgery

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

If you need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Surgery for osteoarthritis may significantly improve your symptoms, mobility and quality of life.

However, surgery cannot be guaranteed to eliminate your symptoms, and you may still experience pain and stiffness from your condition.

There are several different types of surgery for osteoarthritis.

Joint replacement

Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints.

During an arthroplasty, your surgeon will replace your affected joint with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last up to 20 years, although it may eventually need replacement.

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.

Joint fusing

If joint replacement is not suitable for you, your surgeon may suggest an operation to fuse your joint in a permanent position, known as an arthrodesis.

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

Adding or removing some bone around a joint

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 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 symptoms of osteoarthritis, although you may need knee replacement surgery eventually.

Complementary and alternative therapies

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

However, there needs to be more medical evidence to suggest they're practical, and they generally are not recommended by the National Institute for Health and Care Excellence (NICE).

Nutritional supplements

Several nutritional supplements have been used to treat osteoarthritis in the past, including chondroitin and glucosamine.

GPs no longer prescribe chondroitin and glucosamine because there's no strong evidence that they are effective as a treatment.

Generally, supplements can be expensive and NICE recommends that they should not be routinely offered.?

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, does not recommend their use.

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