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Treatments and drugs

By Mayo Clinic staff

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Illustration showing hip replacement Hip replacement
Illustration showing a healthy knee, a knee with osteoarthritis and knee that has undergone knee replacement surgery Knee replacement
Illustration showing artificial shoulder joint positioned during shoulder replacement surgery for osteoarthritis Shoulder replacement

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks.

Medications

  • Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask your doctor for guidance on limiting or abstaining from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you're taking it.
  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. Oral NSAIDs can cause stomach upset, so some prescription NSAIDs come in a patch that you affix to your skin or in a gel form that you can rub on the painful joint. Other NSAID side effects include ringing in your ears, cardiovascular problems, and liver and kidney damage. The risk of major side effects is greatest if you use NSAIDs at high dosages for long-term treatment.
  • Tramadol. Tramadol (Ultram) is a centrally acting analgesic that's available by prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects — such as stomach ulcers and bleeding — than those of NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in combination with acetaminophen to increase pain relief.
  • Stronger painkillers. Prescription pain pills, such as codeine and propoxyphene (Darvon), may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
  • Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.

Therapy

  • Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.
  • Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  • Try braces or shoe inserts. Consider trying special splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.
  • Take a chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips and tricks for reducing and coping with joint pain.

Surgical and other procedures

  • Viscosupplementation. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid. Viscosupplementation is only approved for knee osteoarthritis, though researchers are studying its use in other joints.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. How long your new joint will last depends on how you use it. Some knee and hip joints can last 20 years. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it can also improve appearance and comfort and may improve your joint's mobility. Joint replacement surgery carries a small risk of infection and bleeding. Artificial joints can wear or come loose and may need to eventually be replaced.
  • Realigning bones. Surgery to realign bones may relieve pain. These types of procedures are typically used when joint replacement surgery isn't an option, such as in younger people with osteoarthritis. During a procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by transferring the force of the joint away from the worn-out part of the knee.
  • Fusing bones. Surgeons can also permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility. Arthrodesis may be an option if you experience severe pain in your joint, but can't undergo joint replacement surgery.
Lifestyle and home remedies Tests and diagnosis
References
  1. Handout on health: Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp. Accessed July 22, 2009.
  2. Mercier LR. Osteoarthritis. In: Ferri FF. Ferri's Clinical Advisor 2009. 1st ed. Philadelphia, Pa.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/152079048-3/0/1701/412.html#4-u1.0-B978-0-323-04134-8..50018-5--subchapter11_8824. Accessed July 22, 2009.
  3. Osteoarthritis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00227. Accessed July 22, 2009.
  4. Lane NE, et al. Osteoarthritis. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/152079048-3/0/1492/1009.html#4-u1.0-B978-1-4160-2805-5..50288-3_12790. Accessed July 22, 2009.
  5. Kalunian KC. Risk factors for and possible causes of osteoarthritis. http://www.uptodate.com/home/index.html. Accessed July 31, 2009.
  6. Kalunian KC. Diagnosis and classification of osteoarthritis. http://www.uptodate.com/home/index.html. Accessed July 31, 2009.
  7. Ehrlich GE. Osteoarthritis. In: Rakel RE, et al. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/152079048-4/869009174/1621/497.html#4-u1.0-B978-1-4160-4435-2..50250-8_3948. Accessed July 22, 2009.
  8. Solomon DH. NSAIDs: Overview of adverse effects. http://www.uptodate.com/home/index.html. Accessed Aug. 10, 2009.
  9. Arthritis Foundation life improvement series programs. Arthritis Foundation. http://www.arthritis.org/programs.php. Accessed July 31, 2009.
  10. Hunder GG. Mayo Clinic Straight Talk on Arthritis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2006:230.
  11. Nutrition and dietary supplements. In: Firestein GS. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/153389597-3/872979471/1807/236.html#4-u1.0-B978-1-4160-3285-4..10034-8--s0250_930. Accessed Aug. 10, 2009.
  12. Ginger. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed July 31, 2009.
  13. Chondroitin sulfate. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed July 31, 2009.
  14. Avocado. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed July 31, 2009.

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Oct. 13, 2009

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