Let’s Talk About Osteoarthritis Treatment
You can’t reverse it, but with some lifestyle changes and pain-management strategies, you can live well with OA.by Jerilyn Covert Health Writer
When you have osteoarthritis (OA), your joint pain can feel like that house guest who just won’t leave. Every time you use the stairs, or bend down, or reach for something, it’s there. And you don’t know how to make it go away. Don’t worry—we’ve got you. While there’s no cure for OA, there are a lot of good options to help you treat the pain. The first step is to educate yourself about those options (so you’re in the right place). Then seek out the experts who can guide you—talk to your doctor about referring you to an orthopedic specialist and a physical therapist. You can’t cure your OA. But you can help yourself feel a whole lot better.
Our Pro Panel
We went to some of the nation’s top experts on osteoarthritis to bring you the most up-to-date information possible.
Brian Feeley, M.D.
Professor of Orthopaedic Surgery and Chief of Sports Medicine and Shoulder Surgery
UC San Francisco and UCSF Health
Arya Nick Shamie, M.D.
Chief of Orthopaedic Spine Surgery and Professor of Orthopedic Surgery and Neurosurgery
UCLA School of Medicine
Ravi Bannuru, M.D.
Director of the Center for Treatment Comparison and Integrative Analysis; Assistant Professor of Medicine
Tufts University School of Medicine
A physician who is an expert in diagnosing and treating disorders of the “musculoskeletal system”—which includes joints, bones, and cartilage. These doctors—including orthopedic surgeons, who (don’t worry) will exhaust all nonsurgical treatment options before recommending surgery—commonly treat osteoarthritis.
Yes! There are actually specific hand exercises designed to improve flexibility and function—especially in the finger joints and base of the thumb, where hand OA is most common. A physical therapist can prescribe hand exercises for you.
Sure, but keep in mind there’s limited evidence to show that dietary supplements—like turmeric and glucosamine—can help treat OA. That doesn’t mean they won’t help. But it doesn’t mean they will, either. Just be sure to talk to your doctor before starting any new supplement.
In some cases, OA can be managed with lifestyle changes and meds alone. In fact, following an exercise plan may help delay the need for surgery—or keep you out of the operating room altogether. However, if you have late-stage OA and nonsurgical treatment options are not enough to manage the pain, your doctor may recommend surgery, likely a joint replacement.
What Is Osteoarthritis, Again?
A quick refresher: Osteoarthritis is the “wear-and-tear” form of arthritis—by far the most common kind. Like all arthritis, OA is marked by joint pain—often described as “dull,” “achy” or “throbbing”—as well as stiffness and swelling. But unlike, say, rheumatoid arthritis (which happens when your immune system misfires and attacks your joints), osteoarthritis is the result of a natural process that happens to all of us, to some extent, as we age.
It all starts with the wear of joint cartilage, a strong, protective cushion that absorbs shock and keeps the bones in your joints from rubbing together. Cartilage can withstand a lot, but what it can’t do is regrow—once it’s gone, it’s gone. As it gets worn out or damaged, which happens with age or from trauma, it loses the spongy, cushion-y qualities that allow it to absorb force. It becomes dry and flaky (and more susceptible to damage) and small pieces break off, irritating and inflaming the thin tissue lining the joint (synovial membrane).
Once that happens, the domino pieces begin to fall. The joint fluid secreted by the synovial membrane degrades—further impairing the joint’s ability to absorb shock. Bone cells respond by creating more bone—called osteophytes, or “bone spurs”—altering the shape and contour of the joint, often causing tendons to fray and sometimes tear. As the joint space narrows, connective tissues stretch and become damaged. Eventually, the cartilage and tissues may wear completely away and bones start grinding against each other, causing much more severe and constant pain.
What Is the Goal of Osteoarthritis Treatment?
The goal of OA treatment is simple—to ease joint pain and keep you moving in all the ways you need to.
Finding the right treatment for you starts with understanding what OA treatments can and can’t do. What they can do is ease your symptoms. What they can’t do is stop the progression of the disease. Thing is, new drug development for OA has been a lot slower than it has for rheumatoid arthritis, because OA progresses verrry slowly—so it takes a long time to track whether a new treatment works. Rheumatoid arthritis and osteoarthritis are two different, distinct diseases.
In fact, the frontline treatment for OA isn’t a drug at all but rather lifestyle changes like exercise and weight loss.
Best Exercise for Osteoarthritis
Exercise is a core treatment for OA—it can help improve joint pain by up to 10 points on a zero-to-100 scale (on average). As pain goes down, function tends to go up—meaning you’ll be able to move faster, for longer, with less pain.
Just keep in mind: It doesn’t work overnight. You’ll likely need to follow a structured exercise program (that is, a specific plan—ideally working out for at least an hour, three times a week; read: not just a random rep or two whenever you feel like it) for about three months before you can increase strength and mobility enough to notice a benefit.
The good news? Once you do see pain improvement, that can be super motivating. So if you ever feel discouraged or demotivated, think of it this way: If you can make it to three months, this exercise thing gets a whole lot easier.
The best strategy is to hire a physical therapist (or a personal trainer who’s qualified to work with people with OA) to design a workout program tailored to your unique needs. And if you’re brand-new to exercise, a physical therapist is a must. Not every exercise is suitable for every type of OA. Example: While yoga is generally recommended for OA, certain poses—such as those that require you to balance on one foot or bend your joints (like your knees) more than 90 degrees—may aggravate arthritis and should be avoided. A physical therapist or qualified personal trainer can prescribe a safe, effective regimen for you.
A quality exercise regimen for OA should include:
Strength training: Also called resistance training, this type of exercise helps you build muscle mass and strength—that helps muscles do a better job of stabilizing and supporting joints, and it shifts some of the load off the joint onto the muscles. You may be picturing big weights—like barbells and dumbbells—and yes, that is one type of strength training. But you can also use resistance bands or your own bodyweight, and still get great results.
Cardio: Aerobic exercise (think brisk walking, cycling, or running) can improve your overall fitness, give you energy and endurance, and help control your weight, putting less stress on the weight-bearing joints of the knees and hips.
Balance and mobility: These moves—yoga and Tai Chi in particular are recommended—can improve balance and “proprioception” (meaning the awareness of the position of your body), improving your ability to control your joints. Plus, mobility exercise improves your range of motion, so you can keep moving in all the ways you need to.
Ideally, you’ll switch up your routine periodically to keep your body guessing (and progressing). You may alternate between a couple different routines, or increase weight, reps, or the length of your workout. Just don’t keep doing the same thing over and over, or your body will adapt and stop making gains.
Keep in mind that it’s normal to have some pain with movement when you have OA, but that shouldn’t keep you from exercising. Follow the two-hour rule: If pain lasts longer than two hours after exercise—or seems unusual or extra severe—that’s a sign you’ve overdone it. Take it easier next time. To ease post-exercise pain, you may try icing or heating the joint—whichever feels most comfortable—for up to 20 minutes.
And if land-based exercise is just too painful? Consider aquatic therapy. The buoyancy of water helps alleviate any strain or pressure on joints while providing enough resistance to strengthen your muscles. An aquatic therapist can help come up with a water therapy program that works for you.
Can Exercise Help Hand OA, Too?
It can! Believe it or not, there are specific hand exercises designed to improve flexibility and function—especially in the finger joints and the base of the thumb. Research backing the benefits of exercise for hand OA is not as robust it is for hip and knee OA. But several small studies have shown a positive impact on hand pain, function, and joint stiffness.
A physical therapist can prescribe hand exercises for you. Examples:
Thumb stretch: Start with your hand in a neutral position. Bend your thumb across your palm to touch the very bottom of your pinkie finger. Return to the starting position, and repeat.
Knuckle bend: Hold your hand and fingers straight with your fingers close together. Bend the top and middle joints of your fingers, keeping the large, bottom knuckles straight (your finger should aim to touch those joints when you bend). Return to the starting position; repeat if you can.
Fist stretch: Rest your forearm, wrist, and hand on a table. Close your fingers into a gentle fist (don’t squeeze!). Slowly open your hand back up, and repeat.
Weight Loss for OA
Did you know that when you walk, a force of three to six times your body weight is exerted on your knees?
That’s why, if you’re overweight or obese, you’ll also want to incorporate diet changes to help you drop pounds—even losing as little as 5% of your body weight (or 10 pounds if you weigh 200) can ease OA pain, improving function.
Not only that, but because fat promotes inflammation, reducing fat stores may help ease pain in any affected joint, even your hands.
Again, it’s smart to hire help. (Why do this alone?) A registered dietitian can help develop a safe, effective weight-loss plan that works for you—plus offer helpful tips for smart eating habits as well as food shopping and meal planning advice. It’s a lot better than wading through the sea of confusing (and often dubious) diet advice online. Your insurance may even cover a portion of the cost. (Medicare will cover it if you have diabetes or kidney disease.)
Medications for OA
While you’re waiting for the benefits of your exercise plan to kick in, your doctor may recommend medication for quick pain relief.
Here are the options, listed roughly in the order they would be recommended:
Topical Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs typically relieve OA pain, and it makes sense to start with a topical version, which will have fewer side effects and drug interactions than oral NSAIDs can. Currently, only one NSAID is available as a topical—diclofenac. Topical NSAIDs are ideal for someone with 1-3 problematic / painful joints. Though even with topicals, it's important to discuss the risks and benefits with your physician(s). It comes in these forms:
gel (Voltaren; available over the counter)
Oral NSAIDs: If a topical NSAID doesn’t work—and you don’t have a history of heart, kidney, or stomach problems—your doctor may suggest oral NSAIDs. Many are available over-the-counter, but if those don’t help enough then prescription strength is an option. Your doc will likely prescribe the smallest effective dose for the shortest amount of time (perhaps every day for a month) to provide fast relief, and then wean you off the drug. NSAIDs are not addictive, although they can lose their effectiveness for pain relief over time so it's important for patients to monitor how effective their NSAID is, especially because switching NSAIDs can often help.
After that, you may be allowed to take it intermittently, as needed. Many OTC NSAIDs are household names, but don’t let that familiarity fool you: They can be dangerous in overdoses—so be sure not to supplement your prescription with an over-the-counter version, or take a higher dose than your doctor prescribes. With roughly 20 to 25 NSAIDs on the market, you have a lot to choose from, including these:
Bufferin, Bayer (aspirin)
Zorvolex, Voltaren (diclofenac) – Also available in topical form
Mobic, Vivlodex (meloxicam)
Celebrex (celecoxib) COX-2 inhibitor, a subclass of NSAIDs that have a lower risk of internal bleeding or stomach ulcers—a common side effect of other NSAIDs that are used in large doses for a long time. It may be an option for people with a history of gastrointestinal (GI) problems.
Cymbalta (duloxetine): You may know this as an antidepressant, but it was also recently approved by the U.S. Food and Drug Administration for OA pain. It may be safer than an NSAID for people with other health conditions, and it may be recommended for OA patients who also have symptoms of depression.
Corticosteroid injections: Steroids injected directly into the joint, by a doctor or radiologist, can provide quick relief to those who are not good candidates for NSAIDs, or who find that NSAIDs don’t do enough. They’ll work for up to three to four months, —but can only be used every six months at the most. Generally considered a short-term fix, steroids used for too long can actually deteriorate cartilage (making OA worse).
Viscosupplementation: For long-term pain relief, you may try viscosupplementation—when your doctor injects a thick fluid called hyaluronic acid, a molecule found in synovial fluid that degrades with age and OA. Fun fact: Hyaluronic injections used to be made from rooster combs (yes, the little red things on roosters’ heads) but now is usually bioengineered in a lab. Restoring the joint’s hyaluronic-acid level helps aid lubrication and shock absorption. You’ll wait a few weeks for the pain relief to kick in, but once it does it can last for up to six months, or sometimes longer. (When it wears off, you may return for another treatment.) Depending on the type of product you use, you may get just one shot, or three to five shots spaced a week apart.
What About Acetaminophen (Tylenol) for Osteoarthritis?
While acetaminophen can relieve OA pain, it tends to be less effective than NSAIDs—and the risks are roughly just as high. For these reasons, they’re usually not recommended to treat OA.
When Is Surgery Required for OA?
If your pain is too severe to manage with lifestyle changes and meds alone—and especially if all the cartilage and tissue has worn away and the bones are rubbing against one another—it’s time to consider surgery. You’ll consult with an orthopedic surgeon who can help you decide if surgery is right for you.
Here are the types of surgery your doctor may discuss with you.
Joint replacement (arthroplasty): If you’re having surgery for OA, chances are it’s a joint replacement—when the damaged ends of the bones are removed and replaced with metal or plastic parts, creating a buffer so your bones won’t rub together.
Success rates are high—about 90% of patients report reduced pain for 10 years after hip replacement, and 85% still have pain relief 10 years after knee replacement. But the outcome for you will depend a lot on your health and level of fitness going into the surgery. Those who are very weak or in poor health are at greater risk of complications.
The drop in pain after joint replacement can be big—the average patient reports a 50-point improvement on a zero-to-100 scale. That can mean being able to do a lot more, with a lot less pain, and perhaps even returning to a beloved activity. Lower-impact activities like tennis, golf, cycling, swimming, and even occasional light jogging may become possible again. (Though, don’t count on any running or jumping.)
Expect to be in the hospital for a day or two, and to do physical therapy for six to eight weeks. You may have to restrict your activities for a little while (no driving) and use a cane or walker until your muscles get used to the new joint and you regain your sense of balance. But pain should subside quickly—for many patients, function improves in as little as one to two weeks.
By two to three months, you should be recovered and able to return to most activities, pending approval from your doctor, of course.
While hip and knee replacements are most common, pretty much any joint can undergo a joint replacement—including shoulders, finger joints, ankles, and elbows.
Joint fusion: If joint replacement fails, or you have very severe foot, ankle, or spine arthritis, your doctor may recommend a fusion—when damaged surfaces of the bones are removed and the bones are joined by plates and screws until they grow (or “fuse”) together. Pain relief can be dramatic, but it comes at a cost: You lose mobility in the joint. Recovery can take several weeks to a year.
Osteoarthritis Surgeries for Younger Patients
If you’re young and active—and your OA is due to repetitive use, a sports injury, or other trauma—and you have early-stage OA in just one part of the joint, you may be a candidate for one of these surgeries.
Osteotomy: An osteotomy involves surgically realigning the joint by removing or adding bone—so some of the forces will be transferred to the part of the joint that’s still healthy. These can be done for hip or knee OA. Recovery is longer—about seven to eight months, with the first six weeks on crutches—but the advantage is once you’re recovered, you have no restrictions. For some patients, this may delay the need for a joint replacement. And for others, it will keep them from ever needing one at all.
Arthroscopy: In this procedure, the surgeon makes a few small incisions, inserting a camera and thin surgical instruments to shave or repair the damaged tissues (cartilage, ligaments, or meniscus—a C-shaped piece of cartilage in the knee). This is most often done in the knee, shoulder, elbow, ankle, hip, and wrist.
Cartilage transplant: A surgeon takes a graft from the healthy part of the joint and transfers it to the part of that joint that’s worn out. Kind of like a hair transplant, only with cartilage.
Complementary Therapies for OA
Evidence for natural and complementary treatments is limited—and many treatments can take weeks to work (if they work at all). But in general, they’re safe to try. Just be sure to talk to your doctor first.
Heat / cold: Heat, cold, and “contrast” therapy (alternating the two) have all been shown to relieve OA pain. Finding what works for you may take some trial and error. But if you find the right combo, it can be a simple, safe way to manage OA pain. Take a warm bath, apply cold compresses, or wrap a bag of frozen veggies in a towel and apply it to your painful joint.
Acupuncture: Most evidence backing acupuncture for OA is anecdotal. But if you’d like to try it, just be sure to find an experienced practitioner. Ask your doc for a recommendation. And keep it mind it can be pricey—$75 to $200 per session. Ask your insurance provider if they’ll cover it.
Low-level laser therapy: A low-power laser is shined on the affected joint in an effort to induce photochemical reactions in cells that may reduce inflammation. Studies have been inconsistent, though some show a positive effect, including one small study from Hungary, where people with knee OA saw significant pain improvement after a month of twice-weekly sessions of laser therapy.
Capsaicin: This extract from hot chili peppers comes as a topical cream, gel, or patch and has been shown to relieve joint pain in as little as three weeks. Fair warning: It burns! But if you can stick it out for the first two weeks, the burning gets a lot more tolerable.
Turmeric: A small 2020 randomized trial found that taking a 500 mg capsule of turmeric twice a day for 12 weeks was more effective than a placebo at reducing pain in people with knee OA. The yellow spice contains a chemical called curcumin that fights inflammation, possibly easing joint pain.
Should I Take Any Supplements for OA?
A few supplements have been investigated for OA, though results are mixed and evidence is limited. Always talk to your doctor before starting a dietary supplement.
Vitamin D: A 2019 study in the journal Nutrients suggests vitamin D supplements may ease joint pain in people who are low in the nutrient.
Fish oil: Research suggests that omega-3 fatty acids, found in fish oil, may fight inflammation, reducing pain and improving function. But evidence on the effect in OA is lacking.
Glucosamine and chondroitin sulfate: Some believe these compounds (found in healthy cartilage) promote cartilage formation and repair and have anti-inflammatory effects. Some research suggests they may relieve OA pain, but results are mixed. (Note these supps should not be taken if you’re on blood thinners.)
- OA Treatments: Osteoarthritis and Cartilage. (2019). “OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.” oarsijournal.com/article/S1063-4584(19)31116-1/fulltext
- Two-hour Rule: Arthritis Foundation. (n.d.) “How hard should you work out?” arthritis.org/health-wellness/healthy-living/physical-activity/success-strategies/how-hard-should-you-work-out
- Ice/heat After Exercise: Mayo Clinic. (n.d.). “Exercise helps ease arthritis pain and stiffness.” mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971
- Yoga and OA: Arthritis Foundation. (n.d.). “Top 5 yoga Myths Debunked.” arthritis.org/health-wellness/healthy-living/physical-activity/yoga/top-5-yoga-myths-debunked
- Hand Exercises for OA: Mayo Clinic. (n.d.). “Hand exercises for people with arthritis.” mayoclinic.org/diseases-conditions/arthritis/multimedia/arthritis/sls-20076952?s=1
- Dietitian for OA: Arthritis Foundation. (n.d.). “Get Nutrition Help from a Registered Dietitian.” arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/get-nutrition-help-from-a-registered-dietitian
- Hip Replacement: Hospitals for Special Surgery. (n.d.). “Hip and Knee Replacement Surgery FAQs.” hss.edu/conditions_hip-knee-replacement-surgery-faqs.asp
- Knee Replacement: Cleveland Clinic. (n.d.). “Knee replacement.” my.clevelandclinic.org/health/treatments/8512-knee-replacement
- Arthroscopy: Mayo Clinic. (n.d.). “Arthroscopy.” mayoclinic.org/tests-procedures/arthroscopy/about/pac-20392974
- Acupuncture and OA: Arthritis Foundation. (n.d.). “Acupuncture for arthritis.” arthritis.org/health-wellness/treatment/complementary-therapies/natural-therapies/acupuncture-for-arthritis
- Laser Therapy and OA: Photomedicine and Laser Surgery. (2009). “The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial.” liebertpub.com/doi/10.1089/pho.2008.2297
- Turmeric and OA: Annals of Internal Medicine. (2020). “Effectiveness of Curcuma longa Extract for the Treatment of Symptoms and Effusion–Synovitis of Knee Osteoarthritis.” acpjournals.org/doi/10.7326/M20-0990
- Vitamin D and OA: Nutrients. (2019). “Vitamin D in the Prevention and Treatment of Osteoarthritis: From Clinical Interventions to Cellular Evidence.” mdpi.com/2072-6643/11/2/243
- Fish Oil and OA: Arthritis Foundation. (n.d.). “Does Fish Oil Fight Osteoarthritis?” blog.arthritis.org/osteoarthritis/fish-oil-for-osteoarthritis/
- Glucosamine and Chondroitin and OA: Arthritis Foundation. (n.d.). “Glucosamine and Chondroitin for Osteoarthritis Pain.” arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/glucosamine-chondroitin-osteoarthritis-pain