The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint swelling. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.
Exercise programs may include:
- Low-impact aerobic activity (also called endurance exercise)
- Range of motion exercises for flexibility
- Strength training for muscle tone
Your health care provider may suggest physical therapy. This might include:
- Heat or ice
- Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis
- Water therapy
Other things you can do include:
- Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly, and may even help prevent flare-ups.
- Avoid staying in one position for too long.
- Avoid positions or movements that place extra stress on your sore joints.
- Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet.
- Try stress-reducing activities, such as meditation, yoga, or tai chi.
- Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.
- Eat foods rich in omega-3 fatty acids, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
- Avoid excessive alcohol and smoking.
- Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3 to 7 days.
- Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.
Medicines may be prescribed along with lifestyle changes. All medicines have some risks. You should be closely followed by a doctor when taking arthritis medicines.
- Acetaminophen (Tylenol) is often the first medicine tried. Take up to 4000 mg a day (two arthritis-strength Tylenol every 8 hours). To prevent damage to your liver, do not take more than the recommended dose. Since multiple medications are available without a prescription that also contain acetaminophen, you will need to include them in the 4000 mg per day maximum. Also, avoid alcohol when taking acetaminophen.
- Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they can carry risks when used for a long time. Possible side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.
- Biologics are used for the treatment of autoimmune arthritis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), rituximab (Rituxan), golimumab (Simponi), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs can improve the quality of life for many patients, but can have serious side effects.
- Corticosteroids ("steroids") help reduce inflammation. They may be injected into painful joints or given by mouth.
- Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide.
- Immunosuppressants such as azathioprine or cyclophosphamide are used to treat patients with rheumatoid arthritis when other medications have not worked.
- For gout, allopurinol (Zyloprim) or febuxostat (Uloric) may be used to lower uric acid.
It is very important to take your medicines as directed by your doctor. If you are having problems doing so (for example, because of side effects), you should talk to your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription.
SURGERY AND OTHER TREATMENTS
In some cases, surgery may be done if other treatments have not worked. This may include:
- Joint replacement, such as a total knee joint replacement