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Osteoarthritis Treatment

Osteoarthritis Treatment

While the underlying process of osteoarthritis (OA) cannot be reversed, the symptoms can often be relieved or significantly improved with self-management strategies (e.g. therapeutic exercise, physical activity, weight management) and medications. Surgery is reserved for severe symptoms that fail to improve with these strategies. The two main goals of osteoarthritis treatment are to control your pain and improve your ability to function.

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Therapies


Physiotherapy

A physiotherapist treating knee osteoarthritisA physiotherapist (PT) can develop an individualized program designed to help you increase your strength, flexibility, range of motion, and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These include exercise prescription, physical interventions, and relaxation, in addition to advising you on other techniques for reducing pain and increasing your overall quality of life. PTs can recommend foot orthotics, knee braces and hand splints.

Occupational therapy

An occupational therapist (OT) can look at what you do in a day and develop a program to help lessen your symptoms and improve your function. An OT can do a home or workplace assessment to identify ways to protect your joints and can recommend tools and aids to help you conserve energy and improve your independence. Examples include use of a cane and raised seats to decrease stress on your hip and knee joints; use of wide gripped tools and utensils to decrease stress on your hand joints; or the use of shoehorns or buttonhooks to help with dressing. OTs can also recommend foot orthotics, knee braces and hand splints.

Other therapies often used to help manage OA symptoms include:

  • Acupuncture, a traditional Chinese therapy, involves pricking the skin or tissues with needles to alleviate pain and treat various physical and mental health conditions. Acupuncture has been shown to yield anti-inflammatory effects and regulation of immune system function. However, research studies have limitations with sample size, effect size, and control variables. Because of its low risk of harm, acupuncture is conditionally recommended. Acupuncture combined with standard arthritis medication strategies may be beneficial in reducing pain and improving quality of life.

  • Massage of muscles and other soft tissues, by a registered massage therapist, may help provide short-term relief of stiffness and pain. Other potential benefits include a reduction in stress and anxiety as well as improved mobility and overall function of the joints. However, evidence of massage therapy’s efficacy in managing arthritis symptoms is insufficient. Many studies do not have sufficient numbers of test subjects and show a high risk of bias. Because of this, massage therapy does have a medium level of recommendation as an arthritis pain management approach. Always consult your family doctor or rheumatologist to see if massage therapy is safe and appropriate for your form of arthritis.

Inform your healthcare provider of any complementary and alternative therapies you are taking, receiving or would like to try. Your healthcare provider can offer valuable advice about these treatments, especially how they may affect other medications and treatments. It’s important to note that treatments such as physiotherapy, occupational therapy, acupuncture and massage are often not covered under government health plans. Some benefits and private health insurance plans will cover a portion of the cost of these therapies up to an annual limit. There may be organizations in your area that offer services at a reduced cost or that are covered by a funding program for eligible individuals.

Your care plan should involve education about osteoarthritis, lifestyle changes such as increasing physical activity, eating healthier, weight-loss, and doing therapeutic exercises.”
- Physiotherapist

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Osteoarthritis medications


Medications for osteoarthritis focus on helping to manage pain and improve joint function. For mild symptoms that come and go, you may benefit from using medication as needed. For stronger symptoms, you may require regular use of medication. The optimal treatment is what is best in each individual case – so speak with your doctor and/or pharmacist about what kind of medications are most appropriate for you.

Medications that may help relieve pain in osteoarthritis come in topical forms (e.g. creams or rubs), pill forms, oils, and injections. Common medications used in OA are described below:

  • Topical treatments

    Topical treatments include non-steroidal anti-inflammatory drug (NSAID) creams and capsaicin cream.

  • Corticosteroid injections

    These injections may relieve symptoms for several weeks to months. Most people tolerate them with few side effects.

  • Acetaminophen

    Acetaminophen has fewer side effects than other pain medications. It is important to stick to the recommended dose, as a higher dose may cause liver damage.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

    If other treatments do not relieve your arthritis pain, you are advised to speak with your pharmacist or doctor about the safety of NSAIDs for you. NSAIDs may reduce pain and inflammation in OA. There are a variety of over-the-counter NSAIDs which include ibuprofen and naproxen sodium. Stronger NSAIDs are available by prescription. If, after checking with your doctor, you are safe to use an NSAID medication, it may work better for your arthritis pain if you take it in combination with acetaminophen.

  • Duloxetine

    This medication has been used to treat a number of chronic pain conditions including osteoarthritis, nerve disorders and fibromyalgia. Duloxetine may be recommended if you do not respond to or cannot tolerate acetaminophen or NSAIDs. It may have added benefit if you are also experiencing depression.

  • Other injections

    There is conflicting evidence for hyaluronic acid injections. There is limited evidence to support platelet-rich-plasma injections for knee OA. Given the cost of these injections and limited evidence, corticosteroid injections are often the first choice.

  • Medical cannabis

    Increasingly, many people with arthritis are exploring medical cannabis as a treatment option for their arthritis. While cannabis can’t cure arthritis or slow disease progression, some people report that it helps to alleviate their symptoms of pain, inflammation and anxiety. There is currently limited evidence available on the efficacy of medical cannabis use for arthritis symptoms, though further research is underway. Visit our Medical Cannabis page to learn more.

    Medical cannabis may not be covered by all drug plans. It is important to check with your insurer about coverage and annual limits. Medical cannabis can be claimed as a medical expense on taxes if obtained with a medical authorization document.

Osteoarthritis treatment medications

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Surgery for osteoarthritis


Surgeon performing hip replacement surgeryWhen OA becomes severe and other therapies are not working, surgery may be considered. The most common surgical procedures for OA include hip and knee replacements.

Joint replacement surgery can be performed at any age, but is usually reserved for patients with advanced arthritis. The decision to undergo surgery depends on the amount of pain and disability your arthritis is causing, as well as the risks and benefits of surgery. This should be discussed further with your doctor.

 

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This osteoarthritis resource was reviewed in February 2021 with expert advice from:

Dr. Sarah E. Ward, MD, FRCSC
Orthopaedic Surgeon, Division of Orthopaedic Surgery
St. Michael’s Hospital
Assistant Professor, Department of Surgery
University of Toronto

Members of the Canadian Arthritis Patient Alliance Steering Committee, including:

  • Linda Wilhelm
  • Janet Gunderson
  • Therese Lane
  • Louise Crane

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This resource was made possible through unrestricted educational grants from:

Arthritis alliance of Canada
Pfizer