What are the treatment options for osteoarthritis (OA)?

From the Guidelines

Treatment for osteoarthritis (OA) should prioritize non-pharmacological approaches, including exercise, weight loss for overweight patients, and assistive devices, as strongly recommended by the 2020 American College of Rheumatology guideline 1.

Non-Pharmacological Treatments

• Exercise, particularly low-impact activities, is crucial for managing OA symptoms and improving quality of life.
• Weight loss is strongly recommended for patients with knee and/or hip OA who are overweight or obese, as it reduces joint stress and slows disease progression.
• Assistive devices such as braces, canes, or shoe inserts can help alleviate pain and improve mobility.

Pharmacological Treatments

• Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for knee OA, providing localized relief with fewer systemic side effects 1.
• Oral NSAIDs can be used for pain management but should be used cautiously due to gastrointestinal and cardiovascular risks.
• Acetaminophen can be used at doses of 325-650mg every 4-6 hours, not exceeding 3000mg daily, for mild to moderate pain.
• Intra-articular corticosteroid injections can provide temporary relief for 1-3 months.

Surgical Options

• When conservative treatments fail, surgical options such as arthroscopy, osteotomy, or joint replacement may be considered for severe cases.
• Joint replacement is recommended for patients with radiographic evidence of knee OA who have refractory pain and disability.

Key considerations in OA management include:

• Individualizing treatment according to patient needs and disease severity.
• Monitoring and adjusting treatment plans regularly to optimize outcomes.
• Prioritizing non-pharmacological approaches to minimize risks associated with pharmacological treatments.

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 treatment options for osteoarthritis (OA) include naproxen, which has been shown to reduce joint pain or tenderness, increase range of motion, and improve mobility.

• Key benefits of naproxen in OA treatment include:
  • Reduction in joint pain or tenderness
  • Increase in range of motion in knee joints
  • Increased mobility
  • Improvement in capacity to perform daily activities 2

From the Research

Treatment Options for Osteoarthritis (OA)

• The treatment of osteoarthritis (OA) involves a combination of non-pharmacological, pharmacological, and surgical procedures 3.
• Pharmacological treatment options include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 3, 5, 6, 7.

Acetaminophen for OA

• Acetaminophen is recommended as a first-line treatment for mild to moderate OA due to its efficacy and relatively benign side-effect profile compared to NSAIDs 4, 3, 6, 7.
• However, some studies have shown that acetaminophen may not be effective in treating symptomatic knee OA, and NSAIDs may be more effective in these cases 5, 6.
• The efficacy of acetaminophen in treating OA is still a topic of debate, with some studies showing it to be effective in alleviating pain, while others show no significant improvement 4, 5, 6.

NSAIDs for OA

• NSAIDs are more effective than acetaminophen in reducing pain and improving global assessments in OA patients, but may have a higher risk of adverse events, particularly gastrointestinal complications 3, 6, 7.
• The use of NSAIDs is recommended for patients with more severe OA symptoms or those who have not responded to acetaminophen treatment 3, 6, 7.

Patient Preference and Treatment Outcomes

• Patient preference studies have shown that patients often favor NSAIDs over acetaminophen, but up to 40% of patients consider acetaminophen to be at least as effective as NSAIDs 3.
• The treatment outcome for OA patients may depend on various factors, including the severity of symptoms, presence of inflammation, and individual patient response to different medications 3, 5, 6.