Treatment Options
Osteoarthritis treatment aims to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.
Drug therapy alongside physiotherapy is the first-line treatment for patients with symptomatic OA. There are a wide variety of NSAIDs available; however, caution should be used when prescribing NSAIDs due to their side effects. - Physiotherapy normally involves
- Patient education
- Exercise therapy
- Activity modification
- Advice on weight loss
- Knee bracing
A combination of supervised exercises and a home exercise program have been shown to have the best results. These benefits are lost after 6 months if the exercises are stopped.
Exercise: Motion as medicine
Lack of exercise and knee osteoarthritis can produce a downward spiral of increasing disability. Lack of exercise makes you more likely to develop knee osteoarthritis; the pain of osteoarthritis makes you avoid exercise, and avoiding exercise makes arthritis worse. The key to breaking this cycle is exercise.
“People may find it surprising that a painful condition can be improved more by exercise than rest.” Regular light to moderate exercise (during which you sweat lightly but can talk easily) can slow the disease process and reduce your pain. The exercise should be individually tailored to prevent injury, so start with an evaluation by a clinician or physical therapist experienced in managing osteoarthritis. A program to improve knee osteoarthritis may include the following:
- Low-impact aerobic exercise
Swim, cycle, walk, or use an elliptical trainer (a machine that simulates walking or stair-climbing without stressing the joints) and gradually increase the time you spend doing it. Also, try to incorporate more activity in your daily tasks—for example, park farther from your destination and walk, or use stairs instead of the elevator.Strengthening the thigh muscles will help protect the knee and improve pain, stiffness, and balance. (For exercises that work the quadriceps, see “Knee strengthening exercises”) If your joints are poorly aligned or the ligaments are overstretched, consult a physical therapist for safe strengthening exercises. Muscle stiffness can limit knee-joint movement and lead to further pain. Stretching and range-of-motion exercises may help. Knee osteoarthritis can interfere with balance by impairing the capacity of receptors in your joints to detect the position of your body in space. You can improve your balance with strengthening exercises as well as specific balance exercises and activities such as tai chi. Lightening the load Every step you take exposes your knee joints to a force equal to three to five times your body weight. If you have osteoarthritis, a weight gain or loss of just 5 pounds can cause a noticeable difference in the amount of pain you feel. One study of overweight or obese older adults who had knee osteoarthritis found that for every pound of weight they lost, the stress on their knees was reduced fourfold. Obesity not only puts added stress on the knees but also spurs the production of inflammatory proteins that may hasten cartilage degeneration. Weight loss can help preserve cartilage and reduce symptoms. “People don’t appreciate the strong connection between obesity and osteoarthritis. If you lose 10% of your body weight, you can reduce pain by 50%.”
Reduce pain with medications
Medications can’t change the course of osteoarthritis, but they can help ease pain and make it possible for you to exercise.
The AAOS suggests using the following medications to control symptoms: acetaminophen (Tylenol), no more than 4 grams per day; nonsteroidal anti-inflammatory drugs (NSAIDs) combined or taken with agents to protect the stomach lining (NSAIDs should also be taken with food); cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex); or topical NSAIDs, such as diclofenac sodium (Voltaren Gel). These recommendations are designed to reduce the risk of gastrointestinal bleeding. Some guidelines also endorse the use of topical capsaicin, a pain-relieving substance found in chili peppers. If you can’t tolerate oral medications or need greater pain relief, your clinician may suggest a corticosteroid injection to reduce inflammation and improve joint function. The effects of a single corticosteroid injection may last for several weeks. (To avoid tissue weakening, corticosteroid injections are given no more often than once every three to four months).Another approach is viscosupplementation—injections of hyaluronic acid, a substance found in joint fluid, to provide added lubrication and cushioning in the knee joint. Several formulations of hyaluronic acid are available. It’s unclear how effective these products are in relieving pain or improving function;
Glucosamine and chondroitin. These popular supplements contain naturally occurring components of cartilage. Despite many studies, it’s still not clear whether they can improve pain and knee function. Any benefit may take weeks or months. Dr. Sandeep Chauhan suggests that you track your pain levels and function (such as walking ability) and discontinue the supplements after six months if they haven’t helped. Glucosamine and chondroitin are unlikely to do you any harm but beware of miracle “cures” and other therapies with little or no supporting evidence. Stick with unbiased information sources, such as the Arthritis Foundation and the American Academy of Orthopaedic Surgeons.
Supportive aids
Depending on the location and severity of your osteoarthritis, you may walk more easily with mechanical support.
There’s some evidence that therapeutic knee taping—the application of tape to better align the knee—can help relieve pain. It’s not entirely clear how taping brings about pain relief, but it’s thought that improved alignment reduces stress on surrounding soft tissues and may help in activating and strengthening the quadriceps muscles. Dr.Sandeep Chauhan can tape your knee and teach you how to do it yourself. Some braces shift the load away from an affected part of the knee, while others support the entire knee. Wedges inserted into the shoes also change the forces acting on the knee Canes and walking frames have been used for walking and help by sharing the load.
Alternative therapies
Certain alternative treatments may have benefits even though the evidence has not been sufficient for their inclusion in professional guidelines. “A treatment might help you, even if it didn’t help enough of the people in the studies that were reviewed,” says Dr. Sandeep Chauhan.
Acupuncture. Trials comparing acupuncture with a sham procedure usually find only small short-term reductions in pain, although some individuals get a better response. Over several months, acupuncture plus exercise hasn’t been found more effective than exercise alone.
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