Because arthritis generally cannot be cured, treatment usually concentrates on alleviating pain and slowing the degeneration of joints. Patients and their families can learn about arthritis, its progression and any limitations or complications the condition may present in their lives. Knowledge about the types of arthritis and likely course of the disease can help people preserve functioning joints and learn ways to manage with joints that are impaired.

Patients may want to keep a pain diary to monitor their symptoms, which can help them report the pain to their physician.

Many lifestyle factors can be adjusted for arthritis. Getting adequate amounts of sleep and resting when experiencing fatigue are important. Resting arthritic joints will also help. Home life can be altered with special fasteners and grips for weakened hands and items such as grab bars in showers and raised toilet seats can prevent falls.

Exercise and loss of excess weight may help certain forms of arthritis, especially osteoarthritis (OA). Maintaining a healthy weight relieves excess strain on the joints. Exercise that maintains muscle tone around joints helps support the joints. People with arthritis should consult their physician before beginning or changing any weight loss or exercise program. Exercise may also be part of a physical therapy program that addresses flexibility, strength, endurance, range of motion, balance and posture and ergonomics.

In addition, assistive devices can support arthritic joints and reduce the stress on them. These include braces, splints, canes, walkers and shoes with inserts. Occupational therapy can offer instruction in ways to conserve energy, modify tasks, protect joints and use adaptive equipment such as jar openers and shower benches.

Nutrition can also play a role. The Arthritis Foundation recommends a diet low in calories and saturated fats and rich in vegetables, fruits and whole grains. Gout patients often need to restrict meat and alcohol, which can trigger attacks.

Other methods of pain management for arthritis may include:

• Heat, cold and water. A physician, physical therapist or occupational therapist can indicate which kind of therapy should be used for treatment. Heat (thermotherapy), such as hot packs, a paraffin hand bath or therapeutic ultrasound, relieves pain, muscle spasm and stiffness. Cold (cryotherapy), such an ice pack, provides a numbing effect and may reduce swelling. Water therapy (hydrotherapy) is often combined with thermotherapy or exercise therapy.

People with some medical conditions, such as poor circulation, should not use cold therapy, and conditions such as impaired sensation (e.g., from diabetic nerve damage) may rule out use of heat therapy.

• Medication. A wide range of prescription and nonprescription medications are used for arthritis pain and inflammation, including:
  
  
• • Acetaminophen. May relieve pain associated with arthritis but does not affect inflammation. Misuse is a common cause of liver damage.
    
    
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Reduce pain and inflammation. They come in prescription and nonprescription forms. Some may affect renal or gastrointestinal function. Commonly used NSAIDs include aspirin, ibuprofen and naproxen. Among the prescription drugs are a group called COX-2 inhibitors. However, several of these were withdrawn from the market because of potentially serious side effects, such as increased risk of cardiovascular side effects.
    
    
  • Disease-modifying antirheumatic drugs (DMARDs). Suppress the overactive response of the immune system for patients with rheumatoid arthritis (RA), juvenile RA, ankylosing spondylitis and psoriatic arthritis. Side effects of DMARDs include liver and kidney complications and repression of immune responses to infection.
    
    
  • Biologic response modifiers (BRMs). Drugs that inhibit the production of the proteins called cytokines, which contribute to inflammation, and slow progression of the disease. Many RA patients respond favorably and achieve lengthy remissions when BRMs are combined with DMARD treatment.
    
    
  • Corticosteroids. May be given as pills or injections into the affected joint. These anti-inflammatories have some benefits for RA patients, but those may diminish over time. Long-term use of corticosteroids is associated with many side effects, such as osteoporosis, fractures, diabetes and glaucoma. Other medications are usually explored first. Repeated corticosteroid injection therapy is not recommended for people with OA.
    
    
  • Opioids. Narcotic analgesics used to treat severe pain.
    
    
  • Antidepressants. Primarily used to treat depression but sometimes prescribed for chronic pain due to arthritis or other conditions.
    
    
  • Creams. Some topical treatments may also alleviate arthritic pain. Capsaicin cream has the same active substance as hot chili pepper and may lessen the pain for OA patients. However, capsaicin may cause burning and redness in some individuals.

• Massage. This can ease pain and stiffness, but the therapist should be familiar with arthritis, the Arthritis Foundation says.
  
  
• Transcutaneous electrical nerve stimulation (TENS). This form of electrical therapy, involving a device with wires and pads, delivers mild electric current to the skin and stimulates nerves to interfere with transmission of pain signals. It can alleviate pain or modify the perception of pain for OA patients.
  
  
• Cognitive behavioral therapy. Patients can learn to replace negative thought patterns with positive ones.
  
  
• Acupuncture and acupressure. Acupuncture is a traditional Chinese procedure in which needles are inserted at specific body points to control pain. Acupressure is a similar method that uses pressure at specific points instead of needles. Studies differ on the value of acupuncture and acupressure for arthritis pain. Some patients with soft tissue pain experience relief. Others show no change.
  
  
• Biofeedback. Patients can be trained to use the mind to help control the body. Limited research suggests biofeedback may ease arthritis, possibly by increasing circulation to joints and reducing inflammation and swelling, the Association for Applied Psychophysiology and Biofeedback says.
  
  
• Supplements. Many people with arthritis take supplements of glucosamine and chondroitin, but research has yielded mixed results. A study sponsored by the National Institutes of Health found that these supplements may help relieve moderate to severe pain from OA of the knee but may be no more effective than a placebo (sugar pill) for mild pain.

The American College of Rheumatology says supplements of fish oil containing omega-3 fatty acids might produce modest relief of arthritic pain, but it does not recommend S-adenosylmethionine (SAMe), an expensive supplement popular in Europe, and cautions that herbal remedies such as willow bark extract, ginger and Chinese thunder god vine may ease pain but can have dangerous side effects.

Supplements and herbs are not regulated by the U.S. Food and Drug Administration. Patients are advised to discuss any treatments or supplements with their physician, including any complementary or alternative medicine therapies.

• Surgery. Several types of surgery can correct arthritic damage. Some of the most common include:
  
  
• • Arthroscopy. A flexible lighted tube is inserted through an incision into a joint to remove debris from the joint cavity or inflamed tissue.
    
    
  • Arthroplasty. Open surgery on damaged joints may also be performed to remove inflamed tissue or fuse parts of the joint. When a joint is severely damaged, surgeons can replace it. Joint replacement is most commonly performed for the knees and hips but can also be performed on some other joints, including the shoulder.
    
    
  • Corrective surgery. May be used on tendons and deformed joints, especially for people with RA.
    
    
  • Spinal surgery. Several types of spinal operations may be performed for patients with severe RA or ankylosing spondylitis, to realign the spine, ease pressure on compressed nerves or fuse the vertebrae.