Most successful osteoarthritis treatment programs involve a combination of treatments tailored to the needs, lifestyle and health of the patient.
The four objectives for the treatment of osteoarthritis are:
- Control pain.
- Improve the function of the joints.
- Maintain a normal body weight
- Achieve a healthy lifestyle
- Exercise.
- Weight control.
- Rest and relief of stress in the joints.
- Pain relief techniques without drugs and alternative therapies.
- Medications to control pain.
- Surgery.
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Exercise
Research shows that exercise is one of the best treatments for osteoarthritis.
Exercise can improve mood and perspective, decrease pain, increase flexibility, strengthen the heart and improve blood flow and maintain weight.
Exercise is also cheap and if done correctly, has few negative side effects. The amount and type of prescribed exercise will depend on the parties involved, the stability of the joints and whether an articulation replacement has been made.
Walking, swimming, and doing water aerobics are some popular types of exercise for people with osteoarthritis.
Your doctor and / or physiotherapist can recommend certain types of exercise depending on your specific situation.
You can use the exercises to stay strong and flexible, improve your cardiovascular status, extend the range of movement of the joints and reduce your weight.
The following types of exercise are part of a well-balanced treatment plan:
- Strengthening exercises : These exercises strengthen the muscles that support the joints affected by arthritis. They can be done with weights or with exercise bands and with low cost devices that add resistance.
- Aerobic activities: These are exercises like brisk walking or low impact aerobics that make your heart pump and can keep your lungs and circulatory system in shape.
- Activities for the range of movement: These keep the joints flexible.
- Balance and agility exercises: These help to maintain skills for daily life.
Ask your doctor or physiotherapist what exercises are best for you. Ask for guidelines on the exercise to be performed when a joint is sore or if inflammation is present.
Also, check if you should:
Use drugs to relieve pain, such as analgesics or anti-inflammatories (non-steroidal anti-inflammatory drugs) to make exercise easier.
Use ice after exercising.
Weight control
If you are overweight or obese, you should try to lose weight.
Weight loss can reduce stress on weight bearing joints, limit the appearance of more injuries, increase mobility and reduce the risk of associated health problems.
A nutritionist can help you develop healthy eating habits. A healthy diet and regular exercise help reduce weight.
Rest and relief of tension in the joints
Treatment plans include scheduled rest.
You must learn to recognize your body's signals and know when to stop or slow down. This will avoid the pain caused by excessive exertion.
Although pain can make it difficult to fall asleep, getting enough sleep is important for managing the pain of osteoarthritis.
If you have trouble sleeping, relaxation techniques, stress reduction and biofeedback may help, as well as the timing of medications to provide maximum pain relief at night. If joint pain interferes with your ability to sleep or rest, consult your doctor.
Some people find relief with footwear and special insoles that can reduce pain or with the use of canes to relieve pressure on aching joints.
They can use splints or braces to provide additional support to the joints and / or keep them in the correct position during sleep or activity. The splints should be used only for limited periods of time, because the joints and muscles need to be exercised to avoid stiffness and weakness.
If you need a splint, an occupational therapist or a doctor can help you get a properly adjusted one.
Relief of non-pharmacological pain and alternative therapies
People with osteoarthritis can find many non-pharmacological ways to relieve pain.
Hot and cold
Heat or cold (or a combination of the two) can be useful for joint pain.
The heat can be applied in different ways (hot towels, hot packs or a hot bath or shower) to increase blood flow and relieve pain and stiffness.
In some cases, cold compresses (ice packs or frozen vegetables wrapped in a towel) reduce inflammation and may relieve pain or numb the painful area.
Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation is a technique that uses a small electronic device to direct soft electrical impulses to the nerve endings that lie under the skin in the painful area. TENS can relieve some of the pain of osteoarthritis. It seems to work by blocking pain messages to the brain and by modifying the perception of pain.
Massage
A massage therapist will massage the aching muscles. This can increase blood flow and heat a stressed area. However, joints with stressed arthritis are sensitive, so the therapist must be familiar with the problems of the disease.
Acupuncture
When conventional medical treatment does not provide sufficient pain relief, people are more likely to try complementary and alternative therapies for the treatment of osteoarthritis.
Some people have found pain relief through acupuncture, a practice in which a licensed acupuncture therapist inserts fine needles at specific points on the skin.
Scientists believe that needles stimulate the release of natural chemicals that relieve pain produced by the nervous system.
Nutritional supplements
Nutritional supplements, such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as well as certain vitamins. It is unknown if these could change the course of the disease.
Medications for pain control
Doctors prescribe medications to eliminate or reduce pain and improve functioning.
Doctors consider a number of factors when choosing medications for their patients with osteoarthritis.
These include:
- The intensity of pain
- Potential side effects of medications
- Medical history (other health problems that have or are at risk of suffering)
- Other medications you are taking.
Because some medications can interact with each other and certain health problems can put you at higher risk of side effects it is important to talk about your medications and your health history with your doctor before you start taking any new medication, and see your doctor regularly while you are taking medication.
By working together, you and your doctor can find the medication that best alleviates your pain with the least risk of side effects.
The following types of medications are commonly used in the treatment of osteoarthritis:
- Over-the-Counter Pain Relievers: Oral analgesics such as acetaminophen are often a primary approach to relieving pain in people with osteoarthritis.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): are a great class of medicines useful against pain and inflammation. Aspirin, ibuprofen, naproxen and naproxen sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work in a similar way by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each one has a slightly different effect on the body.
- Agents of action or narcotics: Tramadol is a synthetic prescription opioid analgesic that is sometimes prescribed when over-the-counter medications do not provide enough relief. It works through the central nervous system to achieve its effects. Tramadol carries risks that do not exist with paracetamol and NSAIDs, including the potential for addiction. Mild narcotic analgesics containing analgesics such as codeine or hydrocodone are usually effective against the pain of osteoarthritis. Due to concerns about the potential for physical and psychological dependence of these medications, doctors usually reserve them for short-term use.
- Corticosteroids : Corticosteroids are potent anti-inflammatory hormones created naturally in the body or made by man for use as a medication. They can be injected into the affected joints to temporarily relieve pain. This is a short-term measure, usually not recommended for more than two to four treatments per year. Oral corticosteroids are not usually used to treat osteoarthritis.
- Hyaluronic Acid Substitutes: Sometimes called viscosupplements, hyaluronic acid substitutes are designed to replace a normal component of the joint involved in joint lubrication and nutrition. Depending on the product your doctor prescribes, it is given in a series of three to five injections. These products are approved only for osteoarthritis of the knee.
- Other medications: Doctors may prescribe other medications for osteoarthritis. These include topical creams to relieve pain and sprays that are applied directly to the skin on the painful joints. They contain ingredients that work in one of three different ways:
- By stimulating the nerve endings to distract the brain's attention from pain in the joints.
- By the depletion of the amount of a neurotransmitter called substance P that sends pain messages to the brain.
- By blocking chemicals called prostaglandins that cause pain and inflammation.
Because most medications used to treat osteoarthritis have side effects it is important to learn as much as possible about the medications you are taking, even those that are available without a prescription.
Certain health problems and daily habits can increase the risk of side effects of NSAIDs. These include a history of peptic ulcers or bleeding from the digestive tract, the use of oral corticosteroids or anticoagulants (blood thinners), smoking and alcohol consumption.
There are steps you can take to help reduce the risk of side effects associated with NSAIDs. These include taking medications with food and avoiding stomach irritants, such as alcohol, tobacco and caffeine.
In some cases, it may help to take other medications along with an NSAID to coat the stomach or block the stomach acids. Although these measures can help, they are not always fully effective.
Questions to ask your doctor or pharmacist about medications
- How often should I take this medicine?
- Should I take this medication with food or between meals?
- What are the side effects ?
- Should I take this medication with other prescription medications?
- Is this medication safe considering other medical conditions that I have?
Surgery
For many people, surgery helps relieve the pain and disability of osteoarthritis.
Surgery can be done to achieve one or more of the following:
- The removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or blockage (arthroscopic debridement).
- Repositioning of the bones (osteotomy).
- Resurfacing of bones.
Surgeons can replace the affected joints with artificial joints called prostheses. These joints can be made of metal alloys, high density plastic, and ceramic material.
Some prostheses are attached to bone surfaces with special cements. Others have porous surfaces and rely on the growth of bone on that surface (a process called biological fixation) to keep them in place.
Artificial joints can last 10 to 15 years or more. Surgeons choose the design and prosthetic components according to their patient's weight, sex, age, activity level, and other medical conditions.
Advances in joint replacement in recent years have included the ability in some cases to replace only the damaged part of the knee joint, leaving undamaged parts of the joint intact, and the ability to perform hip replacement through smaller incisions.
The decision to use surgery depends on several factors, including age, patient's occupation, level of disability, pain intensity, and the degree to which arthritis interferes with your lifestyle.
After surgery and rehabilitation the patient usually feels less pain and swelling and can move more easily.