Osteoarthritis results from the breakdown of cartilage in the joint. Cartilage is a protective cover over the surface of the bones in a joint which allows them to slide smoothly over one another. Breakdown of this cartilage causes inflammation which may be seen around the joint as redness and swelling.
This inflammation also causes pain and difficulty moving the affected joint. In osteoarthritis, pain doesn’t only come from the joint itself. It may also come from nearby muscles, tendons and ligaments. The main goal of osteoarthritis treatment is to relieve pain and restore joint function. Treatment includes exercise, lifestyle changes, medication and surgery.
Exercise helps decrease stiffness and maintain joint function. Exercise also strengthens muscles around the joints. For example, exercise to strengthen the thigh muscles will help stabilize the knee joint. Exercises include range of motion and strengthening. The best type depends on the seriousness of the osteoarthritis and the joint involved. Your doctor or physiotherapist can help you decide on the best exercise for you. For some people, pool exercises can be very helpful. Physiotherapy may also include the use of heat, cold or ultrasound waves to relieve pain and swelling.
A high body mass index (being overweight) puts increased stress on joints. Weight loss helps when weight-bearing joints, such as the hips, knees, or the back, are affected. It may improve joint function and decrease pain. Proper posture when lifting, standing and sitting also reduces stress on the joints.
Acetaminophen (Tylenol™, Extra Strength Tylenol™, Tylenol™ Arthritis)
This medication is recommended first in the treatment of osteoarthritis. It has been shown to be most effective when taken regularly three to four times daily, not only when the pain is intolerable. This drug is safe when taken in the recommended doses on the bottle (maximum of 4 grams per day). People with liver disease or high alcohol intake should check with their doctor or pharmacist about the best dose for them. Acetaminophen does not have stomach side effects. It is less likely to interfere with other medications than the anti-inflammatory drugs.
Glucosamine and Chondroitin Sulphate
These non-prescription drugs are shown to have some benefit in some people for the treatment of osteoarthritis. Although non-prescription, they can react with prescription medication. It is, therefore, important to check with your doctor or pharmacist before you start these drugs. The proven effective dose is 50 milligrams three times a day, but caution is needed with these tablets. With herbal medication the quality control on the amount of active ingredient in each tablet may not be strictly controlled as it is in prescription drugs. Doses may vary between brands and between different bottles of the same brand. Glucosamine and chrondroitin sulphate are the only herbal products that at this time have been scientifically shown to have some effect on osteoarthritis.
Anti-inflammatory drugs (NSAIDS)
These are the “Aspirin™-like” drugs that have been shown to be effective in osteoarthritis, and some of them are now available without prescription. Examples include ibuprofen, indomethacin, ASA, diclofenac, and naproxen. They are best taken in short courses (two to three weeks) when the arthritis is especially bad. They work well in most people, but sometimes you need to try several different anti-inflammatory medications before you find one that works best for you. The most common side effect of these medications is indigestion. In most people this is not serious, but in some there can be serious bleeding in the stomach. Those most likely to be at risk for this are the elderly and those people who have had previous stomach ulcers. These medications can also affect the kidneys, causing blood mineral problems, fluid retention and high blood pressure. If you already have high blood pressure you need to be very cautious with these drugs. Combining an anti-inflammatory with something to protect the stomach can prevent the stomach side effects. However, this does not protect against the kidney side effects.
Selective anti-inflammatory drugs (COXIBs)
These drugs, which include celecoxib and rofecoxib, are the newest anti-inflammatory drugs available. They are safer than the older drugs as far as the stomach side effects are concerned, and are less likely to cause severe stomach bleeding. However, they still need to be taken cautiously by people with high blood pressure (even if it is being treated) and poor heart function, as they can affect kidney function.
In some people, a steroid injection into a particularly painful joint (or inflamed tissue around the joint) can be very helpful. The benefit is usually felt within a few days, although it may only last two to three months.
In the last stages of osteoarthritis the normal joint is usually so badly damaged that it is not possible to control the pain or improve the function. In this case surgery can be very helpful. The damaged joint is replaced with an artificial joint that works and is free of pain. The joints most commonly replaced are hips and knees. A major key to success is dediated exercise after the surgery to restore the muscle function lost while the joint was too painful to use.
Osteoarthitis can usually be managed with a combination of medication, exercises and lifestyle changes. What works for your neighbour or friend may not work for you, or even be safe for you to try. See your doctor for a proper diagnosis and discuss the treatment best for you. Most forms of treatment do not provide instant relief and require persistence as well as the proper medication doses.