Treatment versus prevention

While it can be difficult to avoid, injuries to a joint can increase the risk of developing osteoarthritis in the same joint, years later. However, maintaining a normal weight for your height and body structure, keeping physically active and avoiding excessive stress on the joints as you get older, can reduce the severity and impact of osteoarthritis. Ways to reduce stress on the joints include:

  • sticking to your ideal weight
  • when exercising, try low-impact activity, such as swimming, pool-walking/running, walking, cycling/exercise bike
  • pacing yourself – instead of attending to the chores that need doing all at once spread them out
  • wearing shoes with thick, soft soles can act as shock absorbers and reduce jarring
  • using a walking stick can reduce the weight and stress on a painful hip or knee joint.

How do I manage osteoarthritis?

There are many things you can do to help manage your arthritis:

  • general exercise – keep moving. Don’t be afraid to use your joints
  • swimming in a heated pool can help
  • massaging the muscles around the joints will help ease pain and help keep you supple
  • mild to moderate disease can usually be managed with painkillers, such as paracetamol or ibuprofen (a non-steroidal anti-inflammatory drug). Make sure you follow the dosage instructions on the packet. A GP may prescribe a different non-steroidal anti-inflammatory drug (if this is appropriate for you) or a stronger paracetamol-based combination painkiller

Should your condition deteriorate to the point where your mobility is severely affected, you may be advised by your GP to see a rheumatologist for specialist advice on medical management, or an orthopaedic surgeon to discuss the possibility of joint replacement surgery.

Treatment with drugs

The medication each person is prescribed and how often they take them differs depending on their disease type and on how they react to the drugs. Some of the most commonly used drugs for osteoarthritis are listed below.

Analgesics

These are pain-relieving drugs, such as paracetamol, that do not affect the arthritis itself, but help relieve the pain and stiffness. They come in varying strengths and the stronger ones are only available on prescription.

An anti-inflammatory gel or cream is the first analgesic to try. Most can be bought over the counter, but stronger gels require a prescription. They are safe with few side-effects and have been shown in some studies to be as effective as some anti-inflammatory tablets. Capsaicin cream is another gel/cream therapy that works by creating heat in the skin overlying the joint, thus distracting from symptoms of pain. Some report benefits with capsaicin particularly those with thumb-based OA.

Paracetamol can also be used, which is available over the counter. It is regarded as a safe medicine with relatively few side effects, however, in excess can damage the liver. Some patients report stomach upset. Never take more than the recommended dose and, if in doubt, talk to your pharmacist or doctor.

Paracetamol-based combination analgesics are also available on prescription. These usually contain opioids in low doses such as tramadol or codeine. Opioids are more likely to cause side effects including constipation or dizziness.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are the most effective pain killer in OA. They include a newer category of NSAID known as 'Coxibs' which have a lower risk of gastro-oesophageal side effects such as heartburn and stomach ulceration. However, all NSAIDs are prescribed with caution because of the potential risk of kidney, liver, stomach or cardiovascular side effects. They can also interact with blood thinning medication used in clotting disorders and cardiac diseases.

An NSAID gel or cream, however, is safe and is a useful first option for most people. If they are ineffective, an NSAID in pill form can be considered, however, this is best discussed with your doctor first. For many people suffering with OA, the benefit of the pain relief might outweigh the potential risk of an oral NSAID which again should be discussed with your doctor.

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