By Laura Hegwer
Having osteoarthritis doesn’t mean you’re destined to have a joint replacement. While surgery may be the way to go if your symptoms are severe, more osteoarthritis treatments are available to help you feel better without surgery.
What is osteoarthritis?
Osteoarthritis occurs when the cartilage that cushions your joints wears away, causing symptoms like pain, stiffness and swelling. If you have knee osteoarthritis — one of the most common types — you may also feel your knee “give out,” says Rachel Welbel, MD, a physiatrist (specialist in physical medicine and rehabilitation) at Rush.
“Knee buckling is common and has to do with fluid in the joint, and it’s not always painful,” Welbel says.
Osteoarthritis is different from rheumatoid arthritis, psoriatic arthritis and gout, which are inflammatory types of arthritis. If you have symptoms, a rheumatologist or physiatrist can determine which type of arthritis you may have, so you can start an appropriate treatment.
Treatments for osteoarthritis
You may find a combination of treatments works best to reduce your osteoarthritis symptoms. Innovative options like low-dose radiation therapy may help when your usual regimen no longer provides relief.
Low-dose radiation therapy for osteoarthritis
Low-dose radiation therapy, or LDRT, was a common treatment for osteoarthritis in the early to mid-20th century but became less popular when new arthritis medications became available. Today, many people with osteoarthritis — including those who are tired of taking daily medicines — are rediscovering LDRT, says Paul Kreinbrink, MD, a radiation oncologist who performs LDRT at Rush.
“Osteoarthritis is a vicious cycle where you have joint damage that starts a cascade of inflammatory changes,” Kreinbrink says. “LDRT works by cutting that inflammation off at the source, so we can hopefully prolong the life of that joint.”
LDRT can be performed on extremity joints like the:
- Knees
- Hips
- Ankles and feet
- Shoulders
- Hands
- Elbows
LDRT may be an option if you’ve already tried medication or physical therapy. Research shows that 60% to 80% of osteoarthritis patients who have LDRT experience at least some relief, which can last for up to a year or more, Kreinbrink says.
Before LDRT, you’ll have a CT scan to help plan your radiation. Treatment involves six 15-minute appointments over two to three weeks. The radiation itself is painless and quick. “It doesn’t take more than a minute to deliver all the radiation a patient needs for their treatment that day,” Kreinbrink says.
Afterward, you have no restrictions and can go about your usual routine without any down time. LDRT uses about 5% of the radiation dose used for cancer therapy, which means lower risks and minimal side effects, he adds. While some patients may note pain relief toward the end of their treatment course, most people feel less joint pain within a few weeks after treatment ends.
Medications
Before trying LDRT, over-the-counter and prescription anti-inflammatory drugs are among the first choices to help reduce arthritis pain. When choosing between a pill, cream or patch, Welbel suggests starting with topical lidocaine or a product containing the nonsteroidal anti-inflammatory drug diclofenac.
“Data shows that topical and oral nonsteroidal anti-inflammatory drugs provide similar pain relief,” she says. Compared to pills, topicals also have fewer side effects and are safer for people with heart or digestive conditions like ulcers.
If you prefer a pill, over-the-counter options include naproxen and ibuprofen, while prescription drugs include celecoxib and meloxicam. Your doctor can suggest a combination of medications that can help reduce your symptoms.
Physical therapy and occupational therapy
Being active builds muscle to stabilize your joint and improve arthritis pain. That’s why Welbel often recommends six to eight weeks of physical therapy, especially for those with knee osteoarthritis.
“By stabilizing your glutes, pelvis, core and quads, you put less pressure on your knee joint,” says Welbel, who is researching the potential benefits of non-structured PT for knee osteoarthritis.
But depending on your type of arthritis, you may not get enough pain relief from PT. “In my experience, shoulder and hip osteoarthritis do not respond as well to physical therapy as knee osteoarthritis,” she says.
If you have osteoarthritis in your elbow or hand, occupational therapy may help you find ways to move with less pain throughout your day. Targeted exercises can improve your flexibility and strength, while splints can ease pressure on some of your joints.
Injections
Injections of corticosteroids at painful joint sites can reduce stiffness and pain. Welbel often recommends starting with a steroid injection if symptoms haven’t improved after six to eight weeks of physical therapy. For some people with hip or shoulder osteoarthritis, she may suggest an injection before PT.
While injections can provide relief without surgery, they do have some risks, including infection and bleeding, Welbel says. Over-reliance on steroid injections can also damage joints over the long term, she adds.
If steroid injections no longer offer relief and you don’t want surgery, hyaluronic acid injections may be an option, especially if you have knee or shoulder arthritis. These drugs work by reducing inflammation — not by creating a “cushion” — in the joint, she explains.
Nutritional counseling
Maintaining a healthy weight can reduce the pressure on your knees and lessen pain in that joint, Welbel says.
Rather than taking costly supplements that have only shown mixed results in clinical studies, she recommends eating an anti-inflammatory diet — high in whole foods, low in processed foods. “Reducing the systemic inflammation from the foods you eat will also help the inflammation in your joints,” she says.
Finding relief from osteoarthritis
With guidance and support from your care team, you may be able to live a more active life with less osteoarthritis pain — and avoid or postpone surgery in the future.
If you’re interested in learning more about how you can find relief from osteoarthritis without surgery, call (888) 352-7874.
