treating osteoarthritis, your doctor
is likely to suggest lifestyle changes (such as specific exercises and weight
loss), assisted devices and medication. All of these are aimed at relieving
pain and optimising joint function.
and weight loss
of pain, it’s important to keep active and do regular exercise. Weight loss can
also make a big difference, as it reduces the pressure on affected joints. Exercise
helps to maintain your range of motion, and develops the stress-absorbing
muscles and tendons around the affected joint. It’s also good for your general
health. Low-impact exercise for 20–30 minutes daily is advised and can be
done with the help of a physiotherapist. Daily stretching exercises are also
or complete immobilisation of a joint for relatively short periods can
accelerate osteoarthritis and also worsen the clinical outcome. While it’s
important to rest painful joints regularly, immobilising a joint will not
relieve the disease – on the contrary, it could make the symptoms worse. The
progression of osteoarthritis of the hips and knees can be slowed down by a
well-planned exercise regime.
devices and aids
insoles or shock-absorbing footwear may benefit both knee and hip
osteoarthritis. Simple elastic knee sleeves can reduce pain and instability in
the knee. Walking aids include a walking stick, crutches or a walking
frame. Protect your hands with either thick gardening gloves or bandages when
using crutches or walking sticks. If your thumb joint is affected, splints will
help to lessen pain and disability.
currently no cure for this chronic long-term disease. Medication is aimed at
managing symptoms, such as pain, swelling around the joints and stiffness,
thereby allowing you to take part in normal daily activities. Medication most
frequently prescribed osteoarthritis include the following:
Analgesics (pain relievers) can be taken
before activities that usually cause pain, or they can be taken to relieve
constant mild to moderate pain. Simple analgesics, such as paracetamol, are
available over the counter and can be taken at regular intervals. It’s
important to never exceed the maximum recommended dosage.
over-the-counter analgesics don’t work, your doctor may prescribe stronger
anti-inflammatory drugs (some are available over the counter), or
non-steroidal anti-inflammatory drugs (NSAIDs). These treat both inflammation
and pain, but can have harmful side-effects, e.g. to the stomach, and should be
avoided by some. Depending on their strength, you may need a prescription for
(coxibs) inhibitors (a newer
kind of NSAID) were developed for use in treating osteoarthritis and rheumatoid
arthritis as they have fewer gastro-intestinal side effects. However, these
should also be used with caution in people who have kidney and heart disease,
high blood pressure, or individuals who had previous strokes.
injections into the
affected joints can relieve pain and inflammation, but it isn’t recommended
that this is done too often, as it could cause damage to the joint.
containing a NSAID or capsaicin (chilli) can be rubbed onto the affected joint.
conflicting evidence if glucosamine sulphate has a role to play in pain
and stiffness management; its efficacy is still unclear. It’s made from shrimp
and crab shells and can therefore not be used if you have a seafood allergy.
drugs and some
oral antidepressants can reduce pain caused by arthritis.
into the knee joints can lead to decreased symptoms of osteoarthritis for a few
weeks, but are generally not advised.
are currently available to stop cartilage breakdown or prevent further damage.
other treatments haven’t relieved pain, or improved the function of the
affected joint, surgical joint replacement may be the next step. This is an
option for people who suffer from osteoarthritis, rheumatoid arthritis, and
post-traumatic arthritis (often the result of a serious injury). Surgery for
damaged joints is very successful, with hip and knee replacements now
joint-replacement operation a damaged joint, or a damaged part of a joint, is
removed by an orthopaedic surgeon. The damaged parts are then replaced by new
parts made of special metals (such as titanium or an alloy of cobalt, chromium
and molybdenum), plastic, ceramic or specific kinds of carbon-coated implants,
depending on where in the body the joint replacement is done. While there are
over 60 types of prostheses or implants, the options are usually limited to
four or five for most people
joints, such as the small joints of the fingers, the wrist joints and the
knuckle joints, and also the shoulder and elbow joints, are now also being
regularly replaced surgically. A particularly successful operation can be
performed for advanced osteoarthritis at the base of the thumb.
for surgery are joint pain that isn’t responsive to medical therapy, or
function impairment. Age alone isn’t a contra-indication to surgery, but joint
replacement is usually deferred in younger individuals, where possible, as the
joint replacements have a lifespan of about 20 years in 80–90% of cases. The
longer you wait for the operation, the lower the chances are of having to
have been major advancements in the field of joint replacements over the last
few decades. These have led to longer-lasting implants and shorter recovery
times, partially as a result of minimally invasive surgery, which wasn’t an
option when the first hip replacements were done in the 1960s. These operations
have led to many people with osteoarthritis being able to live pain-free, and
to have greater mobility.
by Dr Stella Botha, rheumatologist at Groote Schuur Hospital, Cape Town (MBChB,
MRCP, PhD). November 2017
Image credit: iStock