Arthritis treatment Surprise — what you can try

What to try when the joint feels stiff

First, move the joint at a comfortable pace each day. Easy walking and steady strength work can make chores easier. Nearby muscles act like a brace around the sore joint.

Heat can loosen stiffness before you start moving. Cold won't undo wear, but it may calm soreness afterward. Hold a cane opposite the side that bothers you.

For a knee or hand, ask about anti-inflammatory gel. You'll rub this medicine on the skin over the joint. Pills spread more of the medicine beyond your joint.

When to arrange a joint visit

Arrange an exam when soreness keeps changing your daily routine. Bring your medicines and any past X-ray report. Show which motions hurt and which ones still feel easy.

QC Kinetix offers visits about non-surgical care for ongoing soreness. Its medical providers are clinic staff who examine joints and perform treatment. Regenerative treatments can include prepared parts of your own blood placed into the joint.

Platelet-rich plasma, called PRP, comes from your blood after it's spun to gather platelets. The prepared part is then put back into the sore joint. You'll want to ask what studies show and what it costs.

What to do when the joint changes fast

Don't wait when a joint becomes hot or very swollen. Fever, a new injury, or trouble standing calls for quick care. New weakness or numbness can't wait for a clinic visit.

A joint that aches slowly often feels worse after use. Rest may help, but the soreness can return with movement. An exam can check if years of wear are involved.

You won't choose a treatment before the visit. Describe when it hurts and name the task you miss. Ask what each choice involves, costs, and requires afterward.

Sources

1. The Lancet Seminar on osteoarthritis states that diagnosis is clinically based despite widespread OVERUSE of imaging, that management should focus on core treatments - self-management and education, exercise, and weight loss where relevant - and that surgery should be reserved for people who have not responded appropriately to less invasive methods.

   Hunter DJ, et al. — Osteoarthritis.. Lancet, 2019. DOI: 10.1016/S0140-6736(19)30417-9.

2. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

3. OARSI designates arthritis education plus structured land-based exercise (with dietary weight management for the knee) as CORE treatments for knee, hip and polyarticular OA. Topical NSAIDs are Level 1A for knee OA. Intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise are Level 1B/2 for the KNEE only and are NOT recommended for hip or polyarticular OA. Acetaminophen is conditionally not recommended, and no oral NSAID is recommended for people with cardiovascular comorbidity or frailty.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

4. The RESTORE randomized clinical trial (n=288) compared three weekly intra-articular injections of leukocyte-poor PRP with saline placebo in symptomatic mild-to-moderate medial knee OA. At 12 months the mean change in knee pain was -2.1 versus -1.8 points (difference -0.4, 95% CI -0.9 to 0.2, P=.17) and the mean change in medial tibial cartilage volume was -1.4% versus -1.2% (P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.