Treatments for osteoarthritis can help with:
- reducing your pain
- increasing your ability to work or do activities you enjoy
- reducing how often your joints become more inflamed and painful (flares)
- improving your health and the health of your joint.
Your healthcare provider or physiotherapist is likely to advise an approach that takes into account the severity of your osteoarthritis, which joints are affected, your symptoms, other medical problems, your age, occupation and everyday activities.
Video: Knee pain info
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(CHESM Thorlene, Australia, 2020)
Changes to your lifestyle
How you manage day-to-day activities can make a big difference to how osteoarthritis affects you. Most of the loss of mobility in the early stages of osteoarthritis can be reversed with a programme of exercises, and dietary change if necessary.
- Regular exercise is one of the best treatments to reduce pain and stiffness, reduce your use of medicines, improve muscle strength, balance, mood and quality of life.
- Eating and drinking well is great for your whole health as well as your joint health.
- If you're 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.
Video: Move and improve
(OsteoArthritis Knowledge, NZ, 2020)
Medicine for osteoarthritis focuses mainly on pain relief. Exercise has been found to reduce osteoarthritis pain as much as most medicines (but without the side effects).
If you're taking medicines for pain, it's best to try lower risk medicines first (eg, paracetamol, anti-inflammatory creams, gels or sprays). If these don't provide enough relief, other medicines (eg, NSAIDs) may be considered – usually for a short period to reduce the risk of side effects. Steroid injections may be recommended for some people.
Paracetamol has a low risk of side effects when used at the recommended dose of 4 grams per day (8 x 500 mg tablets, or 6 x 665 mg tablets per day).
- You may need lower doses (3 grams per day) if you're dehydrated, weigh less than 50 kilograms, have liver problems or drink a lot of alcohol.
- 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 doesn't provide enough pain relief when used alone, it can be combined with other pain relief options like NSAIDs.
When taking paracetamol it's important to:
- avoid any over-the-counter products that contain paracetamol, such as cold and flu medicines
- keep your alcohol intake within recommended limits
- use dosing aids (eg, pillboxes) to assist with taking the correct doses at the correct times. Taking your paracetamol dose too soon after the previous dose, or taking more than your daily limit, can cause serious liver problems.
Non-steroidal anti-inflammatory (NSAID) creams or gels
NSAID creams or gels (eg, diclofenac and ibuprofen) can be bought over-the-counter from your pharmacy. They're 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're 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 are redness or itching on the affected area.
Capsaicin cream is another example of topical pain relief. It's 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 twice 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 if you have ongoing pain and discomfort despite treatment with paracetamol, and have severe symptoms or a flare.
- NSAIDs are effective in reducing the signs of inflammation including redness, warmth, swelling and pain.
- They can cause serious side effects, eg, stomach bleeding, increased risk of heart attacks and stroke, and kidney problems. They're not suitable for everyone and they're not usually recommended as a long-term treatment. However, some people may need to take them on an ongoing basis.
- Check with your healthcare provider or pharmacist to see if NSAIDs are suitable for you. They 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 they don't improve joint function or stiffness.
- They're used for treating flares.
- Repeating steroid injections every 3 months doesn't reduce pain and may cause increased cartilage loss. Regular steroid injections are not recommended.
- Injections into the joints have a very small risk of causing infection.
Opioid medicines (eg, codeine or tramadol) are not recommended for managing pain from osteoarthritis. Opioids are no better than other pain-relieving medicines for improving your ability to do your daily activities. They 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. 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 evidence to show that they help. Some people may find them beneficial but it's not always clear how they're working. Some products may interfere with prescribed medicines. It's a good idea to talk to your healthcare provider or pharmacist if you're thinking about using any of these.
Examples of therapies include:
- Manual therapy (eg, stretching, soft tissue and/or joint mobilisation and/or manipulation) may improve pain or function over the short term for some people.
- Heat or cooling, eg, a hot bath or cooling pack on the affected joint.
- TENS (transcutaneous electrical nerve stimulation). Read more on the non-medication treatments for pain page.
- Glucosamine, chondroitin and fish oil have been suggested for use in osteoarthritis. The evidence suggests that fish oil doesn't help people with osteoarthritis. Glucosamine or chondroitin may reduce pain to a small degree that is not enough for most people, and the effect is only short-term.
If you're considering the use of complementary or alternative treatments, it's important to consider the risks, benefits and costs. Read more about the considerations of using complementary or alternative therapy.
If your joint changes, pain and disability are all severe and a comprehensive management programme including the above measures isn't helping, a joint replacement may be necessary. See: knee replacement and hip replacement.