Because osteoarthritis (OA) cannot be cured, treatment concentrates on controlling pain, improving function and slowing the degeneration of joints. Knowledge about the likely course of OA may help people preserve or improve function of joints and learn ways to manage the condition.

Many OA treatment methods may also be used to slow the progress of joint degeneration or prevent further damage. For instance, many lifestyle factors can be adjusted for OA, including getting adequate amounts of sleep, resting when experiencing fatigue, avoiding activities that place stress on the joints and wearing appropriate shoes and clothing.

Regular exercise can help maintain muscle tone and improve flexibility and range of motion for joints. Research indicates that exercise may slow progression of OA and strengthen cartilage in the joints.

Although it is uncertain whether weight loss slows the progression of OA in affected joints, it can alleviate joint stress and pain. One recent study of overweight people with knee OA indicated that every pound shed yielded a four-pound reduction in force on the knees during every step, which could slow the progression of the disease. An analysis of several studies concluded that overweight people with OA could reduce disability by losing only 5 percent of their weight.

OA patients may also benefit from physical therapy or occupational therapy. Physical therapy can improve flexibility, strength, endurance and range of motion. All of these factors may help reduce the symptoms of OA and prevent further deterioration. Physical therapists can also evaluate and provide assistive devices to help with joint stability and movement. These devices can include braces or splints, canes, walkers and electric power lifts.

Occupational therapy can help OA patients with their activities of daily living (ADLs). Occupational therapists (OTs) can evaluate the patient and provide exercises and recommendations on ways to execute tasks such as dressing, bathing and household chores. OTs can provide the patient with adaptive equipment to make activities easier, especially for arthritic hands. Examples of this equipment include reachers, jar openers, adapters to make dressing easier and larger grips for utensils. In addition, an OT can conduct a home assessment to recommend changes (e.g., grab bars in the shower, raised toilet seats) that will make everyday activities easier for individuals with OA.

The following OA treatment methods may also be used for symptomatic relief:

• Heat, cold and water therapies. A physician, physical therapist or occupational therapist can indicate which kind of therapy should be used for treatment. Heat (thermotherapy), such as ultrasound therapy, relieves pain, muscle spasm and stiffness. Cold (cryotherapy) relieves pain 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 may rule out use of heat therapy.
  
  
• Medication. Many prescription and nonprescription medications are used for OA pain. Some of these include:
  
  
• • Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are used to reduce pain and inflammation. They come in prescription and nonprescription forms and include gels that have demonstrated effectiveness in relieving OA pain in the knees.
    
    
  • Acetaminophen. This over-the-counter analgesic may relieve mild pain associated with OA.
    

• • Injection therapy. Hyaluronic acid is a synthetic version of the fluid in the joint capsule. A physician may inject it into joints of a patient who does not receive pain relief from noninvasive treatments. Corticosteroids may be injected in cases where OA is confined to a few joints and pain cannot be relieved with NSAIDs. The use of corticosteroid injections for OA is somewhat controversial. Physicians recommend no more than three or four injections a year for weight-bearing joints.
    
    
  • Topical analgesics. Capsaicin cream, which has the same active substance as hot chili pepper, can lessen the pain for OA patients. A newer kind of NSAID patches are available and may be of some use for pain relief if applied locally.
    
    
• Electrical therapy, such as transcutaneous electrical nerve stimulation (TENS). This treatment 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, especially those with knee pain.
  
  
• Supplements. Many people use supplements such as glucosamine and chondroitin as complementary and alternative therapies to help relieve the chronic pain of OA. These supplements are not medications and are not regulated by the U.S. Food and Drug Administration (FDA). The studies of their effectiveness have not been conclusive, although most evidence indicates the supplements cause no harm. A study of knee OA sponsored by the National Institutes of Health (NIH) indicated that glucosamine and chondroitin can help relieve moderate to severe pain but in general may be no more effective than a placebo (sugar pill).
  
  
• Acupuncture and acupressure. These alternative treatment methods are based on traditional Chinese practices about specific body points that control pain. Acupuncture uses needles inserted at these points. Acupressure applies pressure to the same points but does not involve needles. Studies differ on the value of acupuncture and acupressure for OA pain. Some patients with soft-tissue pain experience relief, but others report no change.
  
• Surgery. Several types of surgery can correct OA damage. Surgery is usually reserved for the most debilitating cases of OA after other treatments have proven ineffective. Types of surgery include:
  
  
• • Arthroscopy. A flexible lighted tube is inserted in a joint to remove fragments of bone or cartilage from the joint capsule. It may also be used to remove the lining of the joint capsule (synovectomy). Arthroscopy may not provide much pain relief to OA patients.
    
    
  • Corrective surgery. May be used on deformed joints and to realign bones (osteotomy).
    
    
  • Fusion (arthrodesis). Surgeons may fuse bones, usually in the spine, or in other areas where the joints are damaged but joint replacement is not an option (fingers, toes or ankle). A fused joint can bear weight but is no longer flexible.
    
    
  • Joint replacement surgery (arthroplasty). Damaged joints may be partially or completely replaced. When a joint is completely degenerated, surgeons can replace the entire joint. This is most commonly performed for the knees and hips but can also be used to treat shoulders and some other joints.

Researchers are studying many potential treatments to slow the progression of OA or reduce pain and disability. These include bioengineered implants of a patient’s own cartilage, osteoporosis treatments such as bisphosphonates and the hormone calcitonin, and injections of botulinum toxin type A (Botox).