Treating Osteoarthritis: Current Options

Ideally, management of osteoarthritis involves a combination of medication and other approaches to reduce pain and maintain or improve function. But even this "full Cadillac approach" largely treats symptoms, "and there's no evidence it slows structural progression of disease," says University of Maryland School of Medicine rheumatologist and professor Marc Hochberg.

Treatment of osteoarthritis includes:

Exercise Research shows that proper exercise reduces pain and improves function. Some exercises maintain range of motion and joint flexibility; others strengthen muscles that support the joints. Low-impact aerobic exercise such as swimming, walking or biking builds strength and helps maintain overall fitness and reduce or maintain weight.

Rest and joint care On the other hand, giving the body a break from exercise and safeguarding joints is also important. Canes and splints can protect joints and relieve pressure. Cushioned, shock-absorbing footwear and wedge-shaped insoles that redistribute weight and reduce joint stress have been shown to relieve symptoms in the knee for some people, as have taping or bracing of the knee.

Self-help programs Studies show that being educated about the disease and taking an active role in its management helps reduce pain, maintain activity and cut down on doctor visits. Programs such as the Arthritis Self-Help Course, offered by the Arthritis Foundation, teach patients about treatments, exercise and relaxation, and coping skills.

Weight control Excess weight puts stress on weight-bearing joints in the knees, hips and feet. Research shows that people who are overweight or obese can reduce the risk of osteoarthritis and may limit further joint damage, especially in the knees, by dropping pounds.

Medications Acetaminophen (e.g., Tylenol) provides pain relief for some people, with few side effects, though it's unclear whether it's as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (brands include Advil and Motrin) and naproxen (Aleve) or the newer COX-2 inhibitors, such as Celebrex and Vioxx. COX-2 inhibitors pose less risk of stomach ulcers and bleeding than other NSAIDs but may pose a slightly increased risk of cardiovascular events, including heart attacks and strokes, according to some studies.

Pain-relieving creams and other topical agents containing capsaicin, methylsalicylate or NSAIDs can also help for mild to moderate pain in some joints, including the knee.

Injections of corticosteroids into an affected joint can provide short-term pain relief but shouldn't be given more than two or three times a year. A series of injections of hyaluronic acid (a thick lubricating substance normally found in joints) into the knee provides longer-term pain relief for some people with moderate forms of osteoarthritis.

Joint replacement and other surgeries Total replacement of the hip, knee and shoulder joints can eliminate pain and restore near-normal function, and is considered the most significant advance of the 20th century for treatment of osteoarthritis. Surgery to smooth rough bone surfaces in the joint or remove loose pieces of bone or cartilage may help relieve pain.

In addition to these established therapies, some other approaches are under investigation:

Glucosamine and chondroitin sulfate While some studies credit these dietary supplements with relieving osteoarthritis pain, many were flawed and most were sponsored by the supplement makers. A large National Institutes of Health (NIH)-sponsored clinical study of the compounds, both alone and in combination, should yield more definitive results. Washington rheumatologist David Borenstein estimates that about one-third of his osteoarthritis patients get pain relief from glucosamine; in contrast, he says, NSAIDs are effective in about 60 to 65 percent. And, he says, glucosamine may not be effective for joints other than the hip and knee.

Acupuncture Some studies indicate that acupuncture may help reduce pain and improve function in some osteoarthritis patients, but results are inconsistent. An NIH-sponsored study, led by the University of Maryland, may provide clearer answers.

Tissue engineering Researchers are investigating techniques in which healthy cells are removed from the patient's joint, genetically altered or used to grow new cells, and injected back into the joint. They are also exploring the use of stem-cell transplantation to produce new cartilage.

For a list of online resources on osteoarthritis (including links to the American College of Rheumatology, the Arthritis Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases), see the National Library of Medicine's Web site.

For information on the Arthritis Self-Help Course, phone the Arthritis Foundation office for your area; phone numbers are available on the foundation's Web site by entering your Zip code, or by calling 800-283-7800.

– Elia Ben-Ari