What are the management options for osteoarthritis in women?

Management Options for Osteoarthritis in Women

The optimal management of osteoarthritis in women requires a comprehensive, multimodal approach that includes physical interventions, behavioral modifications, and pharmacological treatments tailored to the individual's specific needs and disease severity. 1

First-Line Non-Pharmacological Approaches

Exercise Therapy

• Strongly recommended for knee and hip OA 1
  • Walking
  • Strengthening exercises
  • Neuromuscular training
  • Aquatic exercise
• Exercise is more effective when supervised
• Should be continued regularly to maintain joint mobility and muscle strength

Weight Management

• Weight loss strongly recommended for overweight/obese women with OA 1, 2
• Reduces joint stress and can significantly improve symptoms
• Even modest weight loss (5-10% of body weight) can provide meaningful symptom relief

Orthoses and Assistive Devices

• For knee OA:
  • Tibiofemoral braces strongly recommended for tibiofemoral OA 1
  • Patellofemoral braces conditionally recommended for patellofemoral OA 1
• For hand OA:
  • First carpometacarpal joint neoprene or rigid orthoses strongly recommended 1
  • Orthoses for other hand joints conditionally recommended 1
• Walking aids (canes, walkers) to reduce load on affected joints

Self-Management Education

• Patient education about OA and its management 1
• Self-management strategies to cope with pain and functional limitations

Pharmacological Management

Topical Treatments

• Topical NSAIDs are first-line treatment for pain relief with fewer systemic effects 2
  • Particularly useful for knee and hand OA
  • Apply 3-4 times daily to affected joints

Oral Medications

• Acetaminophen/Paracetamol (up to 4g/day)

  • Safe first choice for pain relief 2
  • Fewer side effects than alternatives

• Oral NSAIDs (when acetaminophen is insufficient)

  • Naproxen 375-500mg twice daily for relief of OA symptoms 3
  • Use lowest effective dose for shortest duration 3
  • Consider cardiovascular, gastrointestinal, and renal risk factors
  • Naproxen has been shown to be comparable to aspirin and indomethacin in controlling disease activity with fewer gastrointestinal side effects 3

Intra-articular Treatments

• Corticosteroid injections

  • Provide short-term relief (4-8 weeks) for acute flares 4
  • Can be repeated but with limited frequency (typically 3-4 times per year)

• Hyaluronic acid injections

  • More expensive but may provide longer symptom relief 4
  • Consider for patients who have inadequate response to other treatments

Treatment Algorithm Based on Disease Severity

Mild OA

1. Exercise therapy and weight management
2. Topical NSAIDs for localized pain
3. Acetaminophen for breakthrough pain

Moderate OA

1. Continue exercise and weight management
2. Oral NSAIDs (if no contraindications)
3. Braces/orthoses for affected joints
4. Consider intra-articular corticosteroid injections for flares

Severe OA

1. Continue all conservative measures
2. Optimize pain management with appropriate analgesics
3. Consider referral for joint replacement surgery when conservative measures fail 4

Common Pitfalls and Caveats

• Overreliance on medications: Many patients focus on pharmacological treatments while underutilizing exercise, weight management, and other behavioral strategies 5
• Inappropriate use of opioids: Opioids should be avoided or used with extreme caution due to risks of dependence and side effects 5
• Supplements: Glucosamine and chondroitin are not recommended due to lack of efficacy according to current guidelines 2
• Stem cell therapy: The American College of Rheumatology/Arthritis Foundation explicitly recommends against stem cell injections due to insufficient evidence of efficacy 2
• Poor adherence to recommendations: Studies show many patients do not follow evidence-based recommendations for OA management 6

By implementing this structured approach to OA management in women, clinicians can help patients achieve better pain control, improved function, and enhanced quality of life.