Treatments for osteoarthritis cannot cure the condition, but can help with:
- reducing the pain
- maintaining your ability to work or do activities you enjoy
- reducing how often your joints become more inflamed and painful (flares)
- preventing joint changes from getting worse.
Your doctor or physiotherapist is likely to advise a treatment that takes into account the severity of the disease, what joints are affected, your symptoms, other medical problems, your age, occupation and everyday activities.
Changes to your lifestyle
How you manage day-to-day activities can make a big difference in the impact osteoarthritis has on your lifestyle. Most of the loss of mobility in the early stages of osteoarthritis can be reversed with a programme of exercises and losing weight if necessary.
- Regular exercise is one of the best treatments to reduce pain and stiffness, reduce your usage of medicines, improve muscle strength, balance, mood and quality of life.
- If you are overweight, weight loss of approximately 10% can result in symptom improvement comparable to the effect of joint replacement surgery.
- Read more about exercise and weight loss.
Medication
Medication for osteoarthritis focuses mainly on pain relief. Usually, the approach is to try milder pain relief medications first, such as paracetamol and gels or sprays, and if that does not provide relief, move to the stronger pain relief medications such as NSAIDs, or steroid injections in some cases. This approach reduces the risk of side effects.
Paracetamol
Paracetamol is recommended for mild pain. It has a low risk of side effects when used at the recommended dose of 4 grams per day (which equates to 8 x 500 mg tablets, or 6 X 665 mg tablets per day).
- You may need lower doses (3 grams per day), if you are dehydrated, weigh less than 50 kilograms, have liver problems or have a high alcohol intake.
- Taking paracetamol at regular times (every 6 hours) is likely to be most helpful, although some people may prefer to use it as needed, only when the pain arises.
- If paracetamol does not provide adequate pain relief when used alone, it can be combined with other pain relief options like NSAIDs or opioids.
When taking paracetamol it is important to:
- avoid any over-the-counter products which contain paracetamol, such as cold and flu medicines
- maintain your alcohol intake within recommended limits
- use dosing aids such as pillboxes to assist with taking the correct doses at the correct times. Taking your paracetamol dose it too soon after the previous dose or taking more than your daily limit, can cause serious liver problems.
Creams or gels (called topical pain relief)
These are useful for people with mild-to-moderate pain, especially when the pain is limited to a few joints or to a specific area such as the knee or finger joints.
Non-steroidal anti-inflammatory (NSAID) creams or gels
NSAID creams or gels such as diclofenac and ibuprofen can be bought over-the-counter from your pharmacy. They are not subsidised – you have to pay the full price.
- These are used by applying a small amount of the cream or gel to the affected joint 3 to 4 times daily.
- You are likely to feel improvements in your symptoms within the first week of treatment, and there may be further improvements in the following weeks.
- Using creams or gels can cause side effects such as stomach bleeding but the risk is lower than when taking NSAID tablets or capsules. The main side effects of NSAID gels or sprays is redness or itching on the affected area.
Capsaicin cream
Capsaicin cream is another example of topical pain relief. It is available on prescription with special approval.
- Apply a small amount of cream to the affected joint 4 times daily. You may get a burning sensation which eases quickly.
- It’s important to wash your hands after applying capsaicin cream to avoid transfer to other areas such as the eyes and mouth.
- You may require treatment for 1 to 2 weeks before you experience a reduction in pain. You can then reduce applications to two times a day.
- Talk to your doctor or pharmacist about whether capsaicin cream is suitable for you. Read more about capsaicin.
NSAID tablets or capsules
Common examples of NSAIDs include ibuprofen (Ibugesic®, I-Profen®, Nurofen®), diclofenac (Voltaren®), naproxen (Noflam®, Naprosyn®) and celecoxib (Celebrex®).
- These are useful for people with ongoing pain and discomfort despite treatment with paracetamol, in people with severe symptoms or during a flare.
- NSAIDs are effective in reducing the signs of inflammation including redness, warmth, swelling and pain.
- These can cause serious side effects such as stomach bleeding, increased risk of heart attacks and stroke and kidney problems. They are not suitable for everyone and are usually not recommended as a long-term treatment but some people may need to take them on an ongoing basis.
- Check with your doctor or pharmacist if NSAIDs are suitable for you. These should be used at the lowest possible dose for the shortest possible time. Read more about the safe use of NSAIDs.
Steroid injection into the joints
These are also called intra-articular corticosteroid injections. Examples include triamcinolone, dexamethasone and methylprednisolone.
- These steroids are given as injections into the painful joint.
- They may provide short-term pain relief, usually for a month, but do not improve joint function or stiffness.
- They are most useful for treating flares.
- Repeating steroid injections every three months does not reduce pain and may cause increased cartilage loss. Regular steroid injections are not recommended.
- Injections in the joints have a very small risk of causing infection.
Weak opioids such as codeine or tramadol
Opioid medication does not improve your ability to do your daily activities more than other pain-relieving medications. Opioid medications may provide small improvements in pain and function but these need to be balanced against the side effects. Side effects include falls, drowsiness, constipation and addiction. Opioids are not recommended for the management of chronic pain. Read more about opioid painkillers.
Complementary or alternative therapies
Complementary or alternative treatments are not usually recommended in the treatment of osteoarthritis, due to a lack of quality evidence or evidence that they are ineffective. Some people may find them beneficial, possibly due to a placebo effect. Examples of therapies include:
- acupuncture
- heat or cooling, such as a hot bath or cooling pack on the affected joint. There is little evidence regarding whether these methods are effective but they are often used because they have a low risk of adverse effects.
- TENS (transcutaneous electrical nerve stimulation) may be helpful if given in a healthcare setting but the use if TENS machines at home has not proven to be helpful.
- Glucosamine, chondroitin and fish oil have been suggested for use in osteoarthritis. The evidence shows that glucosamine and fish oil probably does not reduce symptoms, and that chondroitin might reduce pain a little.
If you are considering the use of complementary or alternative treatments, it is important to consider the risks, benefits and costs. Read more about the considerations if you are using complementary or alternative therapy.
Surgery
If joint changes, pain and disability are all severe and a comprehensive management programme including the above measures is not helping, a joint replacement may be necessary. See: Knee replacement and Hip replacement
