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A successful treatment program for osteoarthritis may involve a combination of therapies tailored to your needs, lifestyle and health. Osteoarthritis treatment has three general goals:

• Control pain through drugs and other measures

• Improve joint care through rest and exercise

• Maintain an appropriate body weight and achieve a healthy lifestyle

In addition to the guidance of your primary health care professional, you may need care from a physical therapist, a rheumatologist (a physician who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and bones) or a physiatrist (a physician who specializes in the diagnosis and management of injuries and diseases causing pain, loss of function and disability). Treatment plans often include the use of exercise, massage, heat, relaxation techniques, splints and braces and local injections to relieve pain.

Osteoarthritis treatment plans also often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery and nontraditional treatments.

If you are diagnosed with osteoarthritis, you may be prescribed a variety of medicines to eliminate or reduce pain and to improve functioning. Health care professionals consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and a drug's potential side effects. You must use medicines carefully, and tell your health care professional about any changes that occur.

The following types of medicines are commonly used in treating osteoarthritis:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some NSAIDs over the counter (for example, aspirin, ibuprofen, naproxen and ketoprofen). Other NSAIDs are available by prescription only. These drugs all reduce inflammation or swelling and relieve pain. However, each NSAID is a different chemical and can have slightly different effects in the body.

  NSAIDs can cause stomach irritation or affect kidney function and blood pressure. Plus, there is the potential for cardiovascular events associated with the use of NSAIDS. The longer you use NSAIDs, the more likely you are to have side effects. Many other drugs cannot be taken with NSAIDs. NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency and hypertension. It's important to ask your health care professional for safety information associated with pain relievers with your personal health history in mind.

  A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2), which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. Celecoxib (Celebrex) is currently the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart attack and stroke; discuss these risks with your health care professional. For more information on the risks associated with Celebrex, visit www.fda.gov.

• Acetaminophen (Tylenol). This analgesic and fever-reducer (antipyretic) is not an NSAID and does not reduce inflammation. It is less likely to irritate the stomach than NSAIDs. Its availability over the counter, low cost and mild side effects make it the drug of choice for treating mild to moderate arthritis pain, but NSAIDS may be a better approach for patients with moderate to severe pain.

  Long-term use of acetaminophen may be associated with liver damage or inflammation of the kidneys (nephritis). Patients with liver disease and heavy alcohol drinkers should not use acetaminophen without first talking to a health care professional.

Health care professionals may prescribe several other medications for osteoarthritis. They include:

• Tramadol hydrochloride (Ultram or Ultracet), which contains Tylenol.

• Rubs and sprays (for example, capsaicin cream) applied directly to the skin.

• Mild narcotic medications (opioids), which, while very effective, are potentially addictive and may have multiple side effects.

• Corticosteroids. These powerful anti-inflammatory hormones are made naturally in the body or produced synthetically. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a short-term measure, not recommended more than two to four times per year.

• Colchicine: This drug is often prescribed to treat crystal arthritis, which sometimes coexists with osteoarthritis. Inflammatory osteoarthritis has been associated with the presence of calcium crystals in the joints, and colchicine helps suppress the inflammation that accompanies these crystals. People who have kidney or liver disease may be unable to use colchicines. Discuss benefits and risks with your health care professional.

• Hydroxychloroquine: In people with severe inflammatory osteoarthritis or those who have bone damage related to the disease, health care professionals may prescribe hydroxychloroquine (Plaquenil), a drug that helps reduce inflammation through its immune-modulating effects. Clinical trials have not confirmed the efficacy of hydroxychloroquine, so its use should be considered experimental.

Medicines used to treat osteoarthritis may have side effects, so it is important to learn about the drugs you are taking. Even nonprescription drugs should be reviewed. Certain patients may be at greater risk for side effects, such as those with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke and those who consume alcohol. The risk of certain side effects in some osteoarthritis medications may be reduced by taking the drug with food. Some patients should avoid stomach irritants such as alcohol, tobacco and caffeine. Other medicines may be taken to protect the stomach lining by coating the stomach or blocking stomach acids. These measures help but are not always completely effective.

Other options for relieving the pain and damage caused by osteoarthritis include:

• Viscosupplements: These medications replace hyaluronic acid (HA), a substance that helps lubricate the joints, which is lost in patients with osteoarthritis. It is approved by the U.S. Food and Drug Administration for the treatment of knee pain in osteoarthritis patients who are unresponsive to nonpharmacologic measures and analgesic medications and who have significantly increased flares of inflammation or extensive inflammation in one or a few joints. The drugs, which include hyaluronan (Hyalgan), hylan G-F 20 (Synvisc), and sodium hyaluronate (Supartz), are injected directly into the joint to replace the hyaluronic acid and help the joint move freely. These injections are typically given weekly over several weeks, and the pain relief may last for a few months. It has no long-lasting effects on viscosity, and some researchers question its effectiveness. Because it is made from rooster combs, people with sensitivity to birds, feathers, or eggs should not receive viscosupplements. Researchers are testing whether hyaluronic acid can slow the progression of osteoarthritis.

• Physical or occupational therapy. The goals of occupational and physical therapy are to preserve the use of your joints, restore lost abilities, maintain your fitness, help you adapt to new levels of activity and help you maintain your ability to partake in the activities you enjoy. Occupational therapy can teach you how to reduce the strain on your joints during daily activity, and physical therapy can teach you exercises designed to preserve the use and strength of your joints. Some of the therapeutic methods available include rest during flare-ups; applying heat or cold; exercise, including range of motion exercises, water exercises, strength exercises, and recreational exercise; specific exercise to help you prepare for or recover from surgery if surgery is prescribed; joint protection activities and exercises; and assistive devices, such as a bath stool in your shower or a shoe horn.

• Surgery. Surgeons may replace affected joints with artificial joints called prostheses, which can last from 10 to 15 years or more. These joints can be made from metal alloys, high-density plastic and ceramic material and can be joined to bone surfaces by special cements. About 10 percent of these artificial joints may need revision. Surgeons choose the design and components of prostheses according to their patient's weight, sex, age, activity level and other medical conditions.

  The decision to perform surgery depends on several factors: level of disability, intensity of pain, weight, interference with lifestyle, age, occupation and other medical conditions. Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint, but many other joints can be replaced, including thumb joints, shoulder joints, and elbow joints. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.

  Recently, a study published in Evidence Report/Technology Assessment compared three treatments of osteoarthritis of the knee—oral supplementation of glucosamine, chondroitin, or the combination; arthroscopic surgery; and intra-articular viscosupplementation (an injection of hyaluronic acid that lubricates the knee joint)—and found that none of them showed clinical benefit. The researchers suggested that new methods of prevention and treatment of osteoarthritis be given a high priority. Discuss the benefits and drawbacks of surgery with your health care professional before you make a decision about whether it’s best for you.

• Weight loss: Weight loss can reduce stress on weight-bearing joints, limit further injury and result in less pain and better function. A dietitian can help you develop healthy eating habits and a nutritional plan to promote weight loss.

• Exercise. Exercise is frequently used to treat osteoarthritis, whether or not a patient is overweight. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise you can do will depend on which joints are involved, how stable the joints are and whether a joint replacement has already been done.

  Exercise can produce generalized improvement as well as specific effects. When it comes to osteoarthritis of the knee, the level of muscle strength in the thigh muscle (quadriceps) is very important. Strengthening this muscle can relieve symptoms and prevent more damage. Walking can result in better functioning and increased walking distance.

  Ask your health care professional or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should use drugs, such as analgesics or anti-inflammatories, to make exercising easier, or if you should use ice afterward. An exercise plan should also include regularly scheduled rest. Learn to recognize your body's signals, and know when to stop or slow down to prevent pain caused by over-exercising.

• Supportive devices. Osteoarthritis pain can be so bad that you need a cane or splints to protect your joints and to take pressure off them. Splints or braces provide extra support for a weakened joint and keep the joint in proper position during sleep or activity. Splints must only be used for limited periods because joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a health care professional can help fit you properly with a splint.

Alternative Therapies for Relieving Arthritis Pain

• Relaxation techniques. Stress reduction and relaxation techniques, such as deep breathing, guided imagery and visualization (where you focus on "seeing" pleasant pain-free scenes or activities in your mind), may provide some pain relief.

• Acupuncture. Acupuncture is an important component of traditional Chinese medicine. It involves the insertion of thin needles at specific points, which are mostly along the body's nerve pathways, to improve health. According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health, acupuncture may be useful as an adjunct treatment or an acceptable alternative treatment option for arthritis pain, when it is part of a comprehensive pain management program. Indeed, a clinical trial showed that acupuncture, when used along with conventional therapy, improved function and reduced pain in osteoarthritis of the knee. Individuals who want to use acupuncture should discuss their interest with their health care team, and only a licensed acupuncturist should be used.

• Nutritional supplements. Few studies have carefully evaluated the role of nutritional supplements in osteoarthritis. However, some studies do suggest that the supplements glucosamine and chondroitin sulfate provide a level of pain relief similar to the level of relief provided by NSAIDS such as aspirin and ibuprofen for individuals suffering from mild to moderate arthritis pain. The results of the two-year Glucosamine-chondroitin Arthritis Intervention Trial (GAIT) found that the combination of glucosamine and chondroitin worked in some patients with moderate to severe pain; however, because of the small size of this subgroup, the findings need to be confirmed in further studies. For patients with mild pain, glucosamine and chondroitin did not provide significant pain relief, either together or alone.

  Glucosamine and chondroitin sulfate are substances naturally produced by the body. The supplements are derived from animal tissue, specifically from crab, lobster and shrimp shells (glucosamine), and from animal (shark) cartilage (chondroitin).

  The FDA does not regulate glucosamine/chondroitin or other food supplements, as it does over-the-counter medications and prescription drugs. If you are considering trying one or both of these supplements, check with your health care professional first. Side effects associated with these supplements include increased intestinal gas and softened stools. If you experience these problems, you might want to try another supplement brand before you stop using them altogether.

  Vitamins C, D and E as well as beta carotene may slow the progress of osteoarthritis, but, again, more research is needed to confirm these claims.

  Products and reports about nutritional supplements claiming to provide pain relief should be viewed with caution until more studies can be conducted. Discuss your interest or questions about such products and reports with your health care professional.

• Transcutaneous electrical nerve stimulation (TENS). TENS is the application of electrical stimulation from a small device to the nerve endings that lie below the skin for pain relief. The use of TENS in people with osteoarthritis is controversial. Some studies have found that people who use TENS for osteoarthritis in the knee experience less pain, greater range of motion and less stiffness. Another study found that the benefits occurred while the TENS unit was actually being used, and yet another study found that TENS was no more effective for relieving pain than the drug naproxen or a placebo.

• Biofeedback. Biofeedback is a way to enhance a body signal so that you are aware of something that usually occurs at a level below consciousness. An electronic device provides information about a body function (such as heart rate) so that you can learn to control that function. If you have arthritis, biofeedback can help you learn to relax your muscles. In this case, an electronic device amplifies the sound of a muscle contracting, so the arthritis patient knows that the muscle is not relaxed. The therapy is typically learned with the help of a health care professional and then practiced at home, either with the use of a biofeedback machine once the patient has mastered the technique, or without one.