Conservative treatment

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)

NICE state (1):

• Non-pharmacological management
  • exercise
    • for all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness)
    • consider supervised therapeutic exercise sessions
    • advise people it may initially cause pain or discomfort but long term adherence to an exercise plan will benefit the joints, reduce pain and improve function
    • consider combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package
  • manual therapy
    • only consider for hip and knee osteoarthritis and alongside therapeutic exercise
  • weight management
    • for people who are living with overweight or obesity:
      • advise them that weight loss will improve quality of life and physical function, and reduce pain
      • support them to choose a weight loss goal
      • explain that any weight loss is likely to be beneficial, but losing 10% is likely to be better than 5%
  • consider walking aids for lower limb osteoarthritis
  • NICE state various non-pharmacological interventions should not be offered:
    • acupuncture or dry needling
    • electrotherapy treatments
    • insoles, braces, tape, splints or supports routinely
      
      
• Pharmacological management
  • topical, oral and transdermal medicines
    • if pharmacological treatments are needed to manage osteoarthritis, use them:
      • alongside non-pharmacological treatments and to support therapeutic exercise
      • at the lowest effective dose for the shortest possible time
    • a topical non-steroidal anti-inflammatory drug (NSAID) should be offered to people with knee osteoarthritis
    • consider a topical NSAID for people with osteoarthritis that affects other joints
    • if topical medicines are ineffective or unsuitable, consider an oral NSAID for people with osteoarthritis and take account of:
      • potential gastrointestinal, renal, liver and cardiovascular toxicity
      • any risk factors the person may have, including age, pregnancy, current medication and comorbidities
        • offer a gastroprotective treatment (such as a proton pump inhibitor) for people with osteoarthritis while they are taking an NSAID
  • NICE state these interventions should not be offered:
    • paracetamol or weak opioids routinely, unless:
      • used infrequently for short term pain relief
      • all other treatments are ineffective or unsuitable
    • glucosamine
    • strong opioids
    • intraarticular hyaluronan injections
  • intraarticular corticosteroid injections should be considered for short term relief when other pharmacological treatments are ineffective or unsuitable or to support therapeutic exercise
    • intra-articular corticosteroids injections are a widely used treatment for pain from symptomatic osteoarthritis (2)
      • systematic reviews show that the treatment effect is modest compared with intra-articular saline (often considered as placebo) and lasts for 2–4 weeks on average

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

Reference:

• (1) NICE (October 2022).Osteoarthritis The care and management of osteoarthritis in adults
• (2) Guermazi A, Hunter DJ, Kloppenburg M. Debate: Intra-articular steroid injections for osteoarthritis - harmful or helpful?☆,☆☆. Osteoarthr Imaging. 2023 Sep;3(3):100163.