What are the treatment options for osteoarthritis (degenerative joint disease)?

From the Guidelines

Osteoarthritis treatment should prioritize a combination of non-pharmacological and pharmacological approaches, with a strong emphasis on weight loss for overweight patients, regular exercise, and the use of topical NSAIDs or oral NSAIDs for pain management, as recommended by the most recent guidelines 1.

Non-Pharmacological Approaches

• Weight loss for overweight patients to reduce joint stress
• Regular exercise to strengthen muscles supporting affected joints
• Physical therapy to improve function and reduce pain
• Assistive devices like canes, braces, or orthotic insoles to improve mobility and reduce pain

Pharmacological Approaches

• Topical NSAIDs such as diclofenac gel (1% applied to affected joints 4 times daily) for localized relief with fewer systemic effects
• Oral NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for moderate pain, used cautiously due to gastrointestinal and cardiovascular risks
• Acetaminophen (500-1000mg every 6 hours, maximum 3000mg daily) for mild pain
• Intra-articular corticosteroid injections (typically methylprednisolone 40-80mg or triamcinolone 20-40mg) for temporary relief, as supported by high-quality studies 1

Additional Considerations

• Hyaluronic acid injections may benefit some patients, particularly in knee osteoarthritis, although the evidence is inconsistent 1
• Platelet-rich plasma is an alternative with some evidence supporting reduced pain and improved function, but concerns regarding cost and safety profile exist 1
• Surgical interventions such as joint replacement may be necessary for patients with severe symptoms unresponsive to conservative measures
• The treatment approach should be individualized based on pain severity, functional limitations, comorbidities, and patient preferences, with the goal of maintaining joint function and quality of life, as emphasized by recent guidelines 1

From the FDA Drug Label

In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease Naproxen can be used for the treatment of osteoarthritis by reducing joint pain and tenderness, and improving mobility and daily activities, as demonstrated in clinical studies 2.

• The therapeutic effects of naproxen in osteoarthritis include:
  • Reduction in joint pain or tenderness
  • Increase in range of motion in knee joints
  • Increased mobility
  • Improvement in capacity to perform daily activities It is essential to consider the potential adverse effects and interactions with other medications when using naproxen for osteoarthritis treatment.

From the Research

Nonpharmacological and Nonsurgical Approaches

• Education, advice, or information about the etiology, progression, prognosis, and treatment options of OA are recommended to be an ongoing and integral part of care 3
• Weight loss (if overweight) is an important core treatment in knee and hip OA 3
• Exercise is a key core treatment in knee, hip, and hand OA and should be considered regardless of age, structural disease severity, functional status, pain levels, or the presence of comorbidities 3
• Walking aids/devices are recommended for both hip and knee OA, while orthoses are recommended for patients with carpometacarpal (CMC) joint OA 3

Pharmaceutical Treatment

• Oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function but are associated with increased risks in patients with certain comorbidities 4
• Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects 4
• Acetaminophen, tramadol, and capsaicin are more controversial, and many updated guidelines offer differing recommendations 4, 5

Emerging and New Treatment Options

• Innovative new treatment options have been developed, including intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), metformin, lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), exosomes, interleukin-1 blockers, gene-based therapy, and bisphosphonate 6
• Antibodies directed against nerve growth factor (NGF-Abs) are a new class of agents under clinical investigation for the treatment of OA 5

Improving Clinical Practice

• Optimal primary care focuses on core OA treatments, namely education for self-management and lifestyle interventions encompassing increased physical activity, therapeutic exercise, and weight loss (if indicated) 7
• Quality indicators are used in clinical practice and research to determine the quality of care and in some settings, are used as knowledge translation tools to address existing evidence-to-practice gaps 7