Learn about 25 treatments for arthritis hip and knee arthritis pain knee including drug and non-drug treatments, and surgery. Guidelines recommend combining drugs with non-medicinal remedies.
Can Vegan or Vegetarian Diets Help Reduce Arthritis Inflammation? Dairy: Arthritis Friend or Foe? Exercise: How Much Is Enough? Can Pain Clinics Help People With RA? What Triggers an Arthritis Flare? A group of 13 experts from around the world reviewed the latest research on OA treatments as the framework for the revised guidelines.
OARSI published its first guidelines in 2008. Patients with OA in one or both knees only and no co-existing conditions such as diabetes, high blood pressure, cardiovascular disease, kidney failure, GI bleeding, depression or obesity. However, one study found that a self-management course did little to improve pain, stiffness or physical function. Researchers have suggested that group educational sessions and telephone-based advice might be helpful, but another study questioned the practicality of these interventions. A variety of exercises, such as strength training, aerobics, range of motion and tai chi, can help with both pain and physical function in knee OA. Strengthening can also help with hip OA pain. Water-based exercises may improve function in both knee and hip joints, but offer only minor benefits for pain.
A 2007 review found reductions in pain and disability in previously overweight patients with knee OA who lost a moderate amount of weight. 20-week period for the treatment to be effective. The benefits of weight loss on hip OA have yet to be proven. A recent analysis of 16 randomized controlled trials found acupuncture was better than sham treatment for relieving OA pain.
However, the effect didn’t reach the threshold for clinical significance. The new guidelines for the first time evaluated the use of balneotherapy, a treatment that involves soaking in warm mineral springs. OA and co-existing conditions, who have few other treatment options. A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain.
A recent study found that TENS didn’t relieve pain better than a sham procedure. While it’s uncertain whether TENS can help with knee-only OA, it’s not appropriate for OA in multiple joints. Knee braces, sleeves, and other devices. One review found knee braces and foot orthoses helpful for reducing pain and joint stiffness and improving function in knee OA, without causing any adverse side effects. Using a cane may reduce pain and improve function in people with knee OA. However, while it takes the load off the knee, it can add more weight onto other affected joints, such as the hip. There isn’t any evidence that crutches are a good alternative to the cane.
Several guidelines recommend acetaminophen as a first-line treatment of mild-to-moderate pain from knee and hip OA. However, because of concerns about risks such as ulcers, GI bleeding, and loss of kidney function in long-term users, current guidelines recommend limiting the dose and treatment time. However, the risk of GI side effects such as ulcers and bleeding is also higher with NSAIDs than with acetaminophen. NSAIDs are also associated with cardiovascular risk and kidney damage. However, people at high risk for side effects like cardiovascular disease or GI bleeding are advised to avoid using NSAIDs entirely.
These rub-on products may be as effective as oral NSAIDs, but they pose less risk of GI problems. And though topical NSAIDs can cause skin irritation, they’re considered a safer option than oral drugs. Topical NSAIDs are recommended for people with knee-only OA. This slow acting drug may slow cartilage breakdown in people with OA. A 2010 analysis found a small benefit for pain relief compared to placebo, but the drug also increased the risk for diarrhea. Though diacerein may be safer than NSAIDs, more high-quality studies are needed to confirm its effectiveness.
This antidepressant, which was evaluated for OA for the first time in these guidelines, may help with chronic pain. However, side effects like nausea, dry mouth, fatigue, constipation, and increased sweating may keep some people from taking it. Duloxetine is appropriate for people with OA of the knee and other joints. Whether people with knee-only OA and coexisting health conditions should take it is uncertain.