What to try first for arthritis treatment Surprise

What to start at home

It's often helpful to begin with movement you can repeat. The joint needs motion, and nearby muscles need steady strength work. A physical therapist can choose exercises and set your pace.

Extra body weight adds pressure to your knees and hips. Choose meals that help you manage that load. Keep a steady bedtime so tiredness doesn't stop your exercise.

For a knee or hand, ask about anti-inflammatory gel. A brace or cane can also steady your walking. A cane works much like a handrail on uneven ground.

What to discuss before taking pills

Some pills ease soreness, but they don't suit everyone. Your other medicines and health history affect what is safe. Ask your doctor or pharmacist to check the full list.

A steroid shot may calm soreness for a short time. The catch is that the effect can wear off. Ask how often the clinic would review another shot.

If home care hasn't helped enough, QC Kinetix can examine you. Its medical providers are clinic staff who assess joints and perform treatment. They may discuss regenerative treatments made from prepared parts of your blood.

When to consider surgery

Surgery may come up when a joint is badly worn. It may also come up when daily life stays limited. You'll want to ask how waiting might affect you.

You'll need your X-ray and a current medicine list. Explain which daily task the soreness prevents. That keeps the visit focused on your needs.

No treatment works the same for every person. Ask about likely help, recovery, cost, and risk. You'll then compare those answers with surgery.

Sources

1. 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.

2. 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.

3. 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.

4. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 studies, with high-quality evidence from 44 trials (3,537 participants) that exercise reduces pain immediately after treatment, and further high-quality evidence that it improves physical function. Benefit attenuates but persists for at least two to six months after the programme ends.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD004376.pub3.

5. In a randomized trial of 156 US Military Health System primary-care patients with knee osteoarthritis, physical therapy beat glucocorticoid injection at one year: mean WOMAC total scores were 37.0 with physical therapy versus 55.8 with injection (mean between-group difference 18.8 points, 95% CI 5.0 to 32.6, lower is better), with secondary outcomes in the same direction.

   Deyle GD, et al. — Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.. N Engl J Med, 2020. DOI: 10.1056/NEJMoa1905877.

6. A BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found that in the pre-specified main analysis of 24 large placebo-controlled trials (8,997 participants), viscosupplementation reduced pain by only SMD -0.08 (95% CI -0.15 to -0.02) - about 2.0 mm on a 100 mm scale - with the confidence interval excluding the minimal clinically important difference of -0.37. Trial sequential analysis indicated conclusive evidence of clinical equivalence to placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

7. 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.

8. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

9. A BMJ systematic review of nine randomized trials found arthroscopic surgery for degenerative knee disease gave only a small pain benefit versus control (effect size 0.14, 95% CI 0.03 to 0.26, equal to 2.4 mm on a 0-100 mm scale), present at three and six months but not later up to 24 months, with NO significant benefit on physical function.

   Thorlund JB, et al. — Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.. BMJ, 2015. DOI: 10.1136/bmj.h2747.

10. In the only randomized trial of total knee replacement (100 patients with moderate-to-severe knee OA), the surgery group improved more on the KOOS4 score at 12 months than the non-surgical group (32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) - but had four times the serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group chose surgery within the year while 74% did not.

    Skou ST, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. N Engl J Med, 2015. DOI: 10.1056/NEJMoa1505467.