Treatment of osteoarthritis

In 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. 

Exercise and weight loss

In spite 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 very important. 

Partial 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.

Assisted devices and aids

Cushioning 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.

Medication

There is 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.

If 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 these.

COX-2 (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.

Cortisone 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.

A topical cream containing a NSAID or capsaicin (chilli) can be rubbed onto the affected joint.

There is 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.

Antimalarial drugs and some oral antidepressants can reduce pain caused by arthritis.

Hyaluronan injections directly into the knee joints can lead to decreased symptoms of osteoarthritis for a few weeks, but are generally not advised.

No drugs are currently available to stop cartilage breakdown or prevent further damage.

Surgery

When 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 commonplace operations.

In a 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

Other 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. 

Indications 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 repeat it.

There 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.

^{Reviewed by Dr Stella Botha, rheumatologist at Groote Schuur Hospital, Cape Town (MBChB, MRCP, PhD). November 2017}

^{Image credit: iStock}