Management
Non-Pharmacologic Interventions
The cornerstones of osteoarthritis therapy, non-pharmacologic interventions include the following:
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Patient education
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Heat and cold
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Weight loss
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Exercise
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Physical therapy
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Muscle training (e.g., quadriceps strengthening for knee OA)
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Occupational therapy
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Unloading in certain joints (e.g., knee and hip)
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Home-based exercise programs show short- to medium-term benefits for symptoms (primarily pain, function, and quality of life) but data on long-term benefits are lacking.
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Strength and resistance training, pulsed electromagnetic field therapy, and transcutaneous electrical nerve stimulation show mostly short-term benefits, whereas agility training shows both short- and long-term benefits.
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Weight loss and general exercise programs show medium- and long-term benefits.
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Intra-articular platelet-rich plasma, balneotherapy, and whole-body vibration show medium-term benefits.
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Glucosamine-chondroitin and glucosamine or chondroitin sulfate alone show medium-term benefits with no long-term benefits for pain or function.
Pharmacologic Therapy
Hand Osteoarthritis
The American College of Rheumatology (ACR)/Arthritis Foundation strongly recommend oral nonsteroidal anti-inflammatory drugs (NSAIDs)—although at doses as low as possible, taken for as short a time as possible—and conditionally recommend using one or more of the following:
- Topical NSAIDs
- Intra-articular glucocorticoid injections
- Acetaminophen
- Duloxetine
- Tramadol
- Chondroitin sulfate
Knee Osteoarthritis
The ACR/Arthritis Foundation strongly recommend topical and oral NSAIDs and intra-articular corticosteroid injections, and conditionally recommend using one of the following:
- Topical capsaicin
- Acetaminophen
- Duloxetine
- Tramadol
The ACR/Arthritis Foundation strongly recommend oral NSAIDs and intra-articular corticosteroid injections (which may be ultrasound guided) and conditionally recommend using one or more of the following for initial management:
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Acetaminophen
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Duloxetine
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Tramadol
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Arthroscopy is indicated for removal of meniscal tears and loose bodies; less predictable arthroscopic procedures include debridement of loose articular cartilage.
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Osteotomy is used in active patients younger than 60 years who have a malaligned hip or knee joint and want to continue with reasonable physical activity. The principle underlying this procedure is to shift weight from the damaged cartilage on the medial aspect of the knee to the healthy lateral aspect of the knee.
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Arthroplasty is performed if all other modalities are ineffective and osteotomy is not appropriate or if a patient cannot perform ADLs despite maximal therapy. This procedure alleviates pain and may improve function. At a minimum, 10-15 years of viability are expected from joint replacement in the absence of complications.
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Fusion consists of the union of bones on either side of the joint. This procedure relieves pain but prevents motion and puts more stress on surrounding joints. Fusion is sometimes used after knee replacements fail.
