conservative treatment

Last edited 04/2021 and last reviewed 10/2021

Conservative treatment of osteoarthritis includes:

• aids, such as a walking stick
• exercise - improvement of the nutrition to the cartilage, physiotherapy to strengthen the capsule and the muscles
  • exercise and weight loss are considered core treatments for patients with osteoarthritis (1)
• analgesia and NSAIDS
  • NICE suggest that paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclo-oxygenase 2 (COX-2) inhibitors or opioids.
    • if paracetamol or topical NSAIDs are insufficient for pain relief for people with osteoarthritis, then the addition of opioid analgesics should be considered. Risks and benefits should be considered, particularly in elderly people
    • topical NSAIDs and/or paracetamol should be considered ahead of oral NSAIDs, COX-2 inhibitors or opioids
    • topical capsaicin should be considered as an adjunct to core treatment for knee or hand osteoarthritis
      
    • rubefacients are not recommended for the treatment of osteoarthritis
      
      
    • use of oral NSAIDs/COX-2 inhibitors
      • where paracetamol or topical NSAIDs are ineffective for pain relief for people with osteoarthritis, then substitution with an oral NSAID/COX-2 inhibitor should be considered
      • where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be considered
      • oral NSAIDs/COX-2 inhibitors should be used at the lowest effective dose for the shortest possible period of time
      • when offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be either a standard NSAID or a COX-2 inhibitor (other than etoricoxib 60 mg). In either case, these should be co-prescribed with a PPI, choosing the one with the lowest acquisition cost
      • if a person with osteoarthritis needs to take low-dose aspirin, healthcare professionals should consider other analgesics before substituting or adding an NSAID or COX-2 inhibitor (with a PPI) if pain relief is ineffective or insufficient
        
        
• injection of local anaesthetic and steroids - there is evidence that intra-articular steroid injections are more effective than placebo for improving symptoms in the short and long term (2)
  • NICE state that intra-articular corticosteroid injections should be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with osteoarthritis (1)
    
    
• intra-articular hyaluronic acid (3) - NICE state that intra-articular hyaluronan injections are not recommended for the treatment of osteoarthritis
  
  
• dietary supplementation - glucosamine sulfate, glucosamine hydrochloride, chondroitin sulfate have been used for patients with osteoarthritis. However NICE state that the use of glucosamine or chondroitin products is not recommended for the treatment of osteoarthritis (1)
  
  
• consider the use of transcutaneous electrical nerve stimulation (TENS) as an adjunctive treatment option for pain relief (1)
  
  
• heel raise to correct unequal leg lengths and thus abnormal joint loads
  
  
• strong analgesia, nerve blocks etc

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

• (1) NICE (February 2014).Osteoarthritis The care and management of osteoarthritis in adults
• (2) Arroll B et al. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ 2004;328:869
• (3) Hiskisson EC, Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology 1999; 38: 602-7.