Non-clinical treatment options
Many patients experiencing osteoarthritis symptoms are overweight. Excess weight does increase strain on all the damaged cartilage tissue which can contribute to a worsening of osteoarthritis symptoms and acceleration of the underlying disease process. Thus, losing weight has the potential to decrease the severity of osteoarthritis symptoms and slow down the progression of the disease. Unfortunately, by the time most patients seek treatment; their symptoms are sufficiently severe that it is difficult for them to effectively exercise in order to lose weight. Thus, it is often necessary to first initiate therapies that can decrease the severity of the osteoarthritis symptoms so that the patient can then subsequently increase their exercise program in order to lose weight.
Physiotherapy is a very important modality for effectively managing osteoarthritis. The central focus of physiotherapy is on maintaining range of motion and strength of the joint, both of which can be compromised by osteoarthritis. Although physio is critically important in enhancing range of motion and regaining and maintaining strength, the timing of the physiotherapy is also important. If aggressive physiotherapy is pursued in an actively inflamed joint, the therapy may exacerbate the inflammatory process making symptoms worse. It is first necessary to bring the inflammatory symptoms under control and then subsequently introduce the range of motion and strengthening program that does not exacerbate inflammation.
Acetaminophen (Tylenol) is a non-narcotic analgesic that can be effective in treating mild to moderate symptoms of osteoarthritis. Acetaminophen does not have any anti-inflammatory activity and is purely an analgesic. As such it avoids many of the complications that are associated with oral anti-inflammatory medications. With regard to narcotic analgesics, there is no place for them in the chronic management of osteoarthritic pain. They may play a limited role in the short term management of severe osteoarthritic pain associated with an acute inflammatory flare up.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be very effective in treating the symptoms of osteoarthritis as they are focused on treating inflammation. They may work extremely well in some patients while they may not work at all in others. The significant problem with these medications is that they are oral systemic medications which can lead to complications such as hypertension, GI bleeding, kidney and cardiac problems. These risks increase with age. Since symptomatic osteoarthritis typically occurs in a single or small number of joints, it is preferable to treat most patients with local therapies rather than with a systemic drug that has significant risk for body-wide toxicity.