Osteoarthritis Treatments By Carol Eustice - Reviewed by a board-certified physician. Updated August 26, 2016 More than 27 million people in the U.S. have osteoarthritis. Specifically, according to the Centers for Disease Control and Prevention (CDC), osteoarthritis affects 13.9 percent of adults aged 25 years and older and 33.6 percent of adults 65 and older. It is the most common type of arthritis. The knees, hands, feet, hips, and spine are the joints most commonly affected by osteoarthritis.People with symptomatic osteoarthritis need effective treatment to control joint pain, stiffness, swelling, and other symptoms. Other goals of treatment include preserving or improving joint function, minimizing disability, and improving quality of life.People with the disease are often confused by so many treatment options—and quite honestly, they would like to skip what doesn't work and focus on what does. There is not one solution for everyone, but researchers have produced guidelines for the treatment of osteoarthritis. Article What Is Arthroscopic Debridement of the Knee? Article Total Knee Replacement vs. Partial Knee Replacement There are non-pharmacologic (non-drug) treatment options for osteoarthritis, pharmacologic (drug) treatments, topical medications, intra-articular injections, lifestyle modifications—and as a last resort, surgery.In 2012, the American College of Rheumatology (ACR), published pharmacologic and non-pharmacologic treatment recommendations for the hand, hip, and knee. The panel of clinical experts offered a strong recommendation, conditional recommendation, or no recommendation for specific treatment options. To be deemed a strong recommendation, high quality evidence was required, as well as evidence that greatly favored benefits versus any risks associated with treatment. A conditional recommendation was associated with a lack of sufficient high quality evidence or evidence that was less distinct when weighing benefits versus risks. If no recommendation was offered, there is inadequate data or no data from randomized, controlled clinical trials. Hand (Pharmacologic Treatment Options)No strong recommendations were made by the experts associated with the ACR in this treatment category. The experts conditionally recommended the use of one or more of the following treatment options:topical capsaicin topical NSAIDs, including trolamine salicylateoral NSAIDs, including COX-2 inhibitors Ultram (tramadol)The expert panel conditionally recommended that the following NOT be used:intra-articular therapies opioid analgesic medicationsAlso, it was conditionally recommended that people with osteoarthritis who are 75 years old or older should use topical NSAIDs rather than oral NSAIDs.Hand (Non-Pharmacologic Treatment Options)There was insufficient evidence available to make strong recommendations in this treatment category as well, but several conditional recommendations were made. Article Is Hyaluronic Acid Injected Into Arthritic Hips? Article Randomized Controlled Trial supporting Total Knee Replacement The ACR conditionally recommends that health professionals (primary care provider, physical therapist, or occupational therapist) should:evaluate the patient's ability to perform activities of daily living give instruction in joint protection techniques provide assistive devices be used to help with activities of daily livingprovide instruction for the use of thermal modalities (i.e., heat and cold)provide splints for people with trapeziometacarpal joint osteoarthritis (base of the thumb)Hip (Pharmacologic Treatment Options)No strong recommendations were made for initial pharmacologic options to treat hip osteoarthritis. Conditional recommendations include use of one of the following medications for initial treatment:acetaminophenoral NSAIDstramadolintra-articular corticosteroid injections Experts conditionally recommend that the following treatment options NOT be used for hip osteoarthritis:chondroitin sulfateglucosamineNo recommendation was made regarding the use of:topical NSAIDsintra-articular hyaluronate injections Cymbalta (duloxetine)opioid analgesic medicationsHip (Non-Pharmacologic Treatment Options)Experts strongly recommend that people with hip osteoarthritis:participate in cardiovascular or resistance land-based exercise, or bothparticipate in aquatic exercise lose weight, if overweightExperts conditionally recommend that people with hip osteoarthritis:participate in a self-management programreceive manual therapy (massage) combined with supervised exercisereceive psychosocial interventionsreceive instruction regarding the use of thermal modalitiesreceive and use walking aids, as is necessaryExperts offered no recommendation with regard to the following treatment options:balance exercise, alone or combined with strengthening exercisestai chimanual therapy aloneKnee (Pharmacologic Treatment Options)No strong recommendations for the initial treatment of knee osteoarthritis were made. Experts conditionally recommend that one of the following be used:acetaminophenoral NSAIDstopical NSAIDstramadol Article Ultrasound Treatment for Osteoarthitis Article What You Need to Know About Joint Replacement Surgery intra-articular corticosteroid injectionsExperts conditionally recommend that people with knee osteoarthritis NOT use:chondroitin sulfateglucosaminetopical capsaicinNo recommendation was made for the use of intra-articular hyaluronates, duloxetine, or opioid analgesic medications.Knee (Non-Pharmacologic Treatment Options)Experts strongly recommend the following non-pharmacologic treatment options for people with knee osteoarthritis:participate in aerobic exercise or resistance land-based exercise, or bothparticipate in aquatic exerciselose weight, if overweightExperts conditionally recommend that people with knee osteoarthritis:participate in a self-management programreceive manual therapy combined with supervised exercisereceive psychosocial interventionsuse medially-directed patellar taping wear medially wedged insoles (if diagnosis is lateral compartment osteoarthritis)wear laterally wedged subtalar strapped insoles (if diagnosis is medial compartment osteoarthritis)receive instruction regarding the use of thermal modalitiesreceive and use walking aids, if indicatedparticipate in a tai chi programNo recommendation was offered for:balance exercise, alone or combined with strengthening exercisewearing lateral wedged insolesreceiving manual therapy alonewearing knee braces using laterally-directed patellar tapingThere also were two treatment options that were conditionally recommended ONLY for people with knee osteoarthritis who have chronic moderate to severe pain and who are candidates for total knee replacement surgery but are unwilling or unable to undergo the procedure:rraditional Chinese acupuncture transcutaneous electrical stimulationTreatment of Other JointsWhile the feet and spine, as well as other joints, were not included in the treatment recommendations from the American College of Rheumatology, many of the guidelines apply to any affected joint—especially pharmacologic recommendations. Osteoarthritis of the spine occurs when there is deterioration in the discs between the vertebrae. Most people with degenerative disc problems do not require surgery and they are helped adequately by conservative treatments. If conservative measures fail, however, surgical options may include lumbar laminectomy, discectomy, or spinal fusion.As with the other joints, treatment of foot osteoarthritis targets the relief of symptoms. Wearing orthotics or foot supports may be helpful. Losing weight if overweight will help all weightbearing joints. If conservative treatment options fail to produce an adequate response, surgery may be considered as a last resort. Arthroscopy, arthrodesis (fusion), or arthroplasty (joint replacement) may be considered, depending on the joint involved in the foot or ankle. The goal of foot surgery is to relieve pain and improve joint function.A Word From VerywellThe American College of Rheumatology recommendations for the treatment of hand, hip, and knee osteoarthritis are based on evidence that was available through 2010. The expert panel included primary care physicians, physiatrists, geriatricians, rheumatologists, an orthopedic surgeon, as well as physical therapists and occupational therapists. The assembled panel provided a multidisciplinary perspective to thoroughly evaluating the evidence.The recommendations are important because there are so many treatment options for osteoarthritis—and a suggestion regarding where to begin is necessary. Most people diagnosed with osteoarthritis utilize a combination of pharmacologic and non-pharmacologic treatment options.Verywell has provided you with this reference document because it is easy to understand and will allow you to discuss your initial treatment options with your doctor. If your response is inadequate, you can also easily see your other options. And, for specific treatments, there are links to more extensive information.Sources:Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care and Research. 2012;Vol. 64 No. 4, pp. 465-474. Kalunian KC. Initial Pharmacologic Therapy of Osteoarthritis. UpToDate. Updated May 19, 2016.Moskowitz RW, et al. Osteoarthritis - Diagnosis and Medical/Surgical Management. Fourth edition. LWW.