What is Supported by Evidence Regarding Osteoarthritis Treatment?

By: Charles Lascano, MD, CAQSM, DABFM.

Sports Medicine Physician. Sanitas Medical Centers.

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Arthritis is a general term that means inflammation of the joints. There are several types of arthritis. Osteoarthritis (OA) is the most common type. When OA sets in, the cartilage begins to break down. As it wears away, the bones in the joint start to rub against each other. This can cause pain, stiffness, and swelling. This article describes treatment options for OA supported by current scientific evidence.

Exercise, tai chi, and physical therapy are the first line of treatment for knee OA. Weight loss is recommended for patients with knee and hip OA. Aquatic exercise has small short-term benefits for OA. Knee bracing has insufficient evidence to draw conclusions about its effectiveness. Acupuncture is at best minimally effective for OA of the knee or hip. Oral glucosamine with or without chondroitin does not appear to be effective in well-designed trials. Vitamin D supplements, antioxidant supplements, or other supplements advertised on the media for OA lack sufficient scientific support to recommend them.

Drug therapy can be started in combination with or after a trial of nonpharmacologic interventions. In general, it is reasonable to begin treatment with Acetaminophen and/or topical therapy and progress to a nonsteroidal anti-inflammatory drug (NSAID) such as Naproxen or Ibuprofen. Acetaminophen is less effective than NSAIDs for OA, but given its safety, a trial at an adequate dosage is appropriate

Corticosteroid injections, which are the only joint injectables usually covered by the insurance plans, improve function, and provide short-term pain relief, but do not improve overall quality of life, according to systematic reviews. A recent large, randomized trial found no benefit and greater cartilage loss in patients receiving corticosteroid injections. Therefore, it can worsen the OA, and are no longer recommended for OA treatment. There are other joint injectables, which are usually not covered by health insurances, like platelet-rich plasma (PRP), hyaluronic acid, stem cell, and prolotherapy, all with limited evidence and more studies are needed to be recommended and covered by all insurance plans.

Joint replacement is an option for patients with moderate to severe pain and radiographically confirmed OA Arthroscopic meniscectomy is no more effective than sham procedures or exercise for knee OA. It is also ineffective for patients with degenerative meniscal tears.