From the Guidelines
Exercise therapy is the most effective treatment for osteoarthritis, with a lower risk of adverse effects compared to oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, and should be prioritized as the first line of treatment. Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage and underlying bone, causing pain, stiffness, and reduced mobility. According to the most recent study 1, exercise therapy has been shown to be more effective in relieving pain and improving function in patients with knee or hip osteoarthritis compared to oral NSAIDs and paracetamol.
Non-Pharmacological Approaches
Some key non-pharmacological approaches for managing osteoarthritis include:
- Weight management
- Regular low-impact exercise, such as swimming or walking for 30 minutes daily
- Physical therapy to strengthen supporting muscles
Pharmacological Approaches
For pain management, the following pharmacological approaches may be considered:
- Acetaminophen (500-1000mg every 6 hours, not exceeding 3000mg daily) as a first-line treatment
- Topical NSAIDs, such as diclofenac gel (apply to affected joint 4 times daily), for localized relief with fewer systemic effects
- Intra-articular corticosteroid injections for temporary relief (3-6 months)
- Hyaluronic acid injections for some patients
Advanced Cases
Advanced cases of osteoarthritis may require surgical interventions, such as joint replacement. The American Academy of Orthopaedic Surgeons (AAOS) has published clinical practice guidelines for the management of osteoarthritis of the knee (non-arthroplasty) 1, which provide recommendations for treatment decisions. The American College of Rheumatology has also published recommendations for the use of non-pharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee 1. However, the most recent and highest quality study 1 prioritizes exercise therapy as the first line of treatment, with a focus on minimizing adverse effects and improving patient outcomes.
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 The answer to the question about Osteoarthritis is that naproxen has been shown to have a therapeutic effect in patients with this condition, as demonstrated by:
- Reduction in joint pain or tenderness
- Increase in range of motion in knee joints
- Increased mobility
- Improvement in capacity to perform activities of daily living impaired by the disease 2 2
From the Research
Osteoarthritis Management
- Osteoarthritis (OA) is a common form of arthritis that can be managed through lifestyle changes and pharmaceutical treatments 3, 4, 5.
- Physical activity, such as adapted physical activity (APA), is a first-line targeted treatment for OA, aiming to reduce pain and activity limitations 3.
- APA can be adapted to a person's health status and includes structured exercise programs for muscle strengthening, joint mobility, proprioception, and aerobic exercises 3.
Lifestyle Changes
- Lifestyle changes, including exercise and weight reduction, are gaining recognition in the management of OA 4.
- Exercise therapy, weight reduction, and footwear changes can be effective in managing OA, particularly for knee osteoarthritis 4.
- Cognitive behavioral change strategies, such as cognitive restructuring, can help patients manage their disease and improve outcomes 6.
Pharmaceutical Treatments
- Pharmaceutical treatments, including oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, and acetaminophen, are commonly used to manage OA 7, 5.
- NSAIDs are generally more effective than acetaminophen in reducing pain and improving function, but are associated with increased risks in patients with certain comorbidities 7, 5.
- Intra-articular corticosteroid injections and hyaluronic acid injections are also used to manage OA, with relatively minor adverse effects 5.
Treatment Recommendations
- The latest recommendations from EULAR, ACR, and OARSI consider APA and pharmaceutical treatments, such as NSAIDs and acetaminophen, as core treatments for people with OA 3, 5.
- Clinicians should consider the latest evidence and recommendations when making informed decisions with patients about treatment plans for OA 5.