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 lifestyle modifications, including weight loss if overweight and regular exercise, as recommended by the 2020 American College of Rheumatology guideline 1.

Key Recommendations

• Weight loss is strongly recommended for patients with knee and/or hip osteoarthritis who are overweight or obese, as it has been shown to benefit pain and function 1.
• Regular low-impact exercise, such as swimming or walking, and physical therapy to strengthen muscles around affected joints are also crucial components of osteoarthritis management 1.
• For pain management, acetaminophen (325-650mg every 4-6 hours, not exceeding 3000mg daily) is a suitable initial option, with NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) considered if insufficient 1.
• Topical NSAIDs, such as diclofenac gel (1% applied to affected joints 4 times daily), can provide localized relief with fewer systemic side effects 1.

Additional Considerations

• Intra-articular corticosteroid injections can provide temporary relief for 3-6 months, but the evidence for hyaluronic acid injections is inconsistent, and their use is not routinely recommended 1.
• Joint protection techniques, assistive devices like canes or braces, and heat/cold therapy can further manage symptoms and improve quality of life 1.
• Surgery, including joint replacement, should be considered when conservative measures fail and pain significantly impacts quality of life 1.

Important Notes

• Oral narcotics, including tramadol, should not be used in the treatment of knee osteoarthritis due to the notable increase in medication-related adverse effects with no consistent improvement in pain and function 1.
• The treatment approach should be tailored to symptom severity and patient needs, with a focus on reducing inflammation, providing pain relief, improving joint function, and slowing disease progression 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 The treatment options for Osteoarthritis (Degenerative Joint Disease) include naproxen, which has been shown to reduce joint pain or tenderness, increase range of motion, and improve mobility and capacity to perform daily activities 2.

• Key benefits of naproxen in osteoarthritis treatment include:
  • 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

From the Research

Non-Pharmacological Treatment Options

• Non-pharmacological approaches are recommended for osteoarthritis treatment, including orthoses, insoles, exercise, diet, and patient education 3
• 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 4
• Weight loss (if overweight) is an important core treatment in knee and hip OA 4
• 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 4
• Walking aids/devices are recommended for both hip and knee OA, while orthoses are recommended for patients with carpometacarpal (CMC) joint OA 4

Pharmacological Treatment Options

• Current treatment options of OA consist of both non-pharmacological and pharmacological modalities, including acetaminophen, nonspecific NSAIDs, and COX-2 specific inhibitors 5
• Many of these drugs, however, are beset with serious side effects 5

Alternative Treatment Options

• Therapeutic exercises decrease pain, increase muscle strength and range of joint motion as well as improve endurance and aerobic capacity 6
• Weight reduction is of proven benefit in obese patients with osteoarthritis of the knee 6
• Walking aids, crutches, shoe insoles, braces and patellar taping are useful tools in some form of osteoarthritis 6
• Therapeutic heat and cold, electrotherapy, ultrasound, acupuncture, hydrotherapy and spa treatment are widely used, although the effects and benefits have not been fully established 6
• Nonpharmacologic interventions include exercise, rest and joint protection, heat and cold, hydrotherapy, therapeutic touch, acupuncture/acupressure, biofeedback, hypnotherapy, cognitive-behavioral techniques, activity and home maintenance modification, nutrition, and transportation interventions 7

Surgical Interventions

• For patients with severe OA not responsive to medical treatment, nonsurgical interventions such as viscosupplements and injectable compounds that mimic healthy synovial fluid or surgical interventions are two likely options 5