Osteoarthritis
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- The most strongly recommended treatments for OA are not pills. They are exercise, learning to manage the condition yourself, and reaching a healthy weight if you carry extra. Three major guidelines (American, international, and European) all agree on this core.
- When medicine is needed, anti-inflammatory gels and tablets (NSAIDs) and steroid injections into the joint are the best-supported options.
- Several popular products are actually recommended against because they do not work for OA, including glucosamine, stem cell and platelet (PRP) injections, and, for the hip, gel (hyaluronic acid) injections.
- If the joint is severely worn and other treatments no longer help enough, joint replacement surgery can be very effective. Your team can refer you to an orthopaedic surgeon to discuss it.
- Which pain medicine is safest depends on your other health conditions. For example, anti-inflammatory tablets are usually avoided if you have heart disease or are frail, and are used more carefully if you have stomach risks.
- Guidelines disagree about gel (hyaluronic acid) injections: one recommends against them, another says they are a reasonable option for the knee. That honest disagreement is why the clinic offers them only after a frank discussion.
Understanding this condition
What osteoarthritis is
Osteoarthritis is a condition of the whole joint. Over time the smooth cartilage that lets bones glide wears thin, the bone underneath changes, small bony growths (called osteophytes) can form, and the joint lining can become inflamed. The result is pain, stiffness, and less easy movement. It usually comes on slowly over years and most often affects the knees, hips, and hands.
Common symptoms
The main symptoms are joint pain that is usually worse with use and better with rest, stiffness that is worst first thing in the morning or after sitting (and usually eases within about half an hour), and a joint that feels less flexible. Some people notice grinding or clicking, swelling, or bony knobs on the fingers. In the knees or hips it can make walking, stairs, and standing up harder.
Who gets it
Osteoarthritis is very common and becomes more likely with age. Worldwide it affects hundreds of millions of people and is a leading cause of disability in older adults. Things that raise the risk include older age, carrying extra weight (especially for the knees and hips), previous joint injury, jobs or activities that heavily load a joint, and a family history.
How it is diagnosed
Osteoarthritis is usually diagnosed from your history and an examination of the joint, without needing many tests. X-rays can show joint changes but do not always match how much pain a person has, so they are not always needed. There is no blood test for OA; blood tests may be used to rule out other kinds of arthritis, such as rheumatoid arthritis or gout. For hand OA, researchers now have agreed 2023 checklists to classify it consistently in studies, but these are research tools, not how your own diagnosis is made.
What to expect over time
Osteoarthritis is a long-term condition that tends to progress slowly over years, though the pace varies a lot from person to person and joint to joint. There is no cure, but symptoms can often be controlled well, and staying active actually helps. When a joint becomes severely worn and treatments no longer control it, joint replacement surgery can restore comfort and function for many people.
Living with and treating it
The goals of treatment
The goals are to reduce your pain, keep the joint moving, and help you stay active and independent. Your plan is built around the joints affected and what matters most to you, and it usually combines several approaches rather than relying on one.
Treatment options
Treatment is layered. For everyone, exercise, weight management if needed, and self-management education are the foundation and are the most strongly recommended. Supports such as a cane, a knee brace, or a thumb splint help for the right joints. For pain, anti-inflammatory gels (topical NSAIDs) are a good first medicine, especially for the knee and hands, and anti-inflammatory tablets (oral NSAIDs) work well. Steroid injections into the knee or hip help for a while. Other options such as acetaminophen, duloxetine, or capsaicin cream can be added. Some popular products are recommended against because they do not help, including glucosamine, PRP and stem cell injections, and hip gel injections. For a severely worn joint, joint replacement can be very effective.
Monitoring and check-ups
Osteoarthritis does not usually need regular blood tests or scans to follow it. Check-ups focus on how your pain and function are doing and whether your plan needs adjusting. If you take anti-inflammatory tablets, your team keeps an eye on your stomach, kidneys, and blood pressure, especially if you use them long term.
Flares and painful spells
Osteoarthritis pain can come and go, with worse spells often triggered by overdoing an activity or, sometimes, weather changes. During a painful spell, easing off (without stopping moving completely), using a topical or oral anti-inflammatory for a while, and heat or cold can help. A steroid injection can settle a stubbornly painful knee or hip. If a joint suddenly becomes very hot, red, and swollen, that needs checking, as it may be something other than OA.
Living well with OA
Staying active is one of the best things you can do, even though it can feel counterintuitive when a joint hurts. Regular exercise that you enjoy, reaching and keeping a healthy weight, using supports like a cane or brace when helpful, pacing your activities, and learning self-management skills all make a real difference. Tai chi is especially well supported for knee and hip OA. Your physiotherapist and occupational therapist can tailor a program to you.
Related problems to consider
Osteoarthritis often travels with other conditions that affect how it is treated, such as extra weight, diabetes, heart disease, and mood changes from living with ongoing pain. These matter because some pain medicines are not safe for everyone. Weak or unsteady muscles can add to the problem, which is another reason exercise helps so much.
What to expect at your appointment
At a visit for OA, expect questions about which joints hurt, when and how much, and how it affects your daily life, along with an examination of the joints. You may or may not need an X-ray. You and your team then build a plan that starts with exercise, weight management if needed, and self-management, and adds treatments to fit you. Your care may involve a team, including your rheumatologist or family doctor, a physiotherapist and occupational therapist, and, when appropriate, the injection clinic or an orthopaedic surgeon.
Osteoarthritis does not have a target number the way some other conditions do. The aim is simply to keep your pain low enough and your movement good enough to do the things that matter to you, reviewed with your team over time.
How treatment is stepped up
- 1
Foundation for everyone
Everyone starts here, and this is the most strongly recommended part of treatment: regular exercise you can stick with, reaching and keeping a healthy weight if you carry extra, and a self-management program to learn skills for daily life. Tai chi is especially good for knee and hip OA. Supports such as a cane, a knee brace, or a thumb splint help for the right joints.
- 2
Topical first for pain
When you need something for pain, an anti-inflammatory gel rubbed on the joint (a topical NSAID) is a good first choice, especially for the knee and hands, because it works with fewer whole-body side effects. Capsaicin cream is another option for the knee.
- 3
Oral medicines and joint injections
Anti-inflammatory tablets (oral NSAIDs) are effective and are used at the lowest dose for the shortest time that works. A steroid injection into a painful knee or hip can help for a while. Other options that may be added include acetaminophen, duloxetine, or, rarely and cautiously, tramadol. Opioids are generally discouraged.
- 4
Severe, end-stage joints: surgery
If a joint is severely worn and other treatments no longer control the pain or let you do what you need to, joint replacement surgery can be very effective. Your team can refer you to an orthopaedic surgeon to talk it through.
Medication guides
Plain-language guides to the medicines used for this condition. Each has a patient and a clinician view.
Living well, beyond the diagnosis
The whole-person side of living with a rheumatic disease, the parts patients tell us matter most. These guides apply across conditions.
When to get medical help
- A joint that suddenly becomes very hot, red, swollen, and painful, especially with a fever. This can be a joint infection or a different kind of arthritis and needs prompt assessment, not just OA treatment.
- A joint that gives way, locks, or that you suddenly cannot put weight on, which should be checked.
- Black or bloody stools, vomiting blood, or bad stomach pain while taking anti-inflammatory tablets (NSAIDs), which can be signs of bleeding and need urgent care.
- Increasing redness, swelling, warmth, or fever in the days after a joint injection, which can signal an infection.
- Pain that is no longer controlled by your current plan or that is stopping you doing daily activities, so your treatment can be stepped up or a surgical opinion arranged.