Nonpharmacologic Treatment
Education is a cornerstone of treatment. Educate each patient about the disease and its treatment options, which should include nonpharmacologic therapies. Patients who better understand their disease process may have better adherence to the treatment plan. The Arthritis Foundation offers a self-help course for patients that is available online at www.arthritis.org/programs.php.

Obesity is a major osteoarthritis risk factor that is highly correlated with the development of osteoarthritis. Weight loss can potentially slow the disease and decrease pain. A referral to a dietitian or bariatric clinic may be necessary for patients who require detailed guidance or more aggressive weight loss. Some patients choose surgical weight loss options including laparoscopic gastric banding.^3,6 Among patients who receive joint replacements, weight loss can potentially extend the life of the implant.¹¹

A fitness program to achieve weight loss, joint strengthening and mobility is a prudent option for patients who are able to exercise. No-impact or low-impact activities are usually more attractive and achievable for patients with osteoarthritis.

Physical or occupational therapy can be useful in symptom management. A physical therapist or occupational therapist can treat symptoms with transcutaneous electronic stimulation, heat, ultrasound, massage and paraffin baths.

The therapist may provide assistive devices to help patients perform ADLs and work functions.¹ Canes or walkers can "unload" or protect a painful joint, and a functional splint or brace may provide pain relief during temporary periods of acute pain and inflammation. To avoid increased stiffness, the use of canes, walkers and splints should be limited to 1 week.

Heat and cold offer other benefits. The application of heat prior to activity may help reduce post-exercise stiffness. Cold application may be comforting during episodes of acute inflammation.

Orthotics or pressure-absorbing shoes may provide some symptomatic relief for patients with osteoarthritis in the knees, spine or hips. Medial or lateral heel wedges can assist in changing an angular deformity of the knees. Instruct all patients to avoid prolonged standing, squatting, kneeling or sitting in low chairs.^3,9

Complementary Therapy
Complementary therapies are becoming more mainstream. Glucosamine and chondroitin might help reduce pain associated with osteoarthritis of the knee. The recommended dosage is 500 mg 3 times per day. Because supplements are not regulated by the FDA, the content of these supplements may be inconsistent between manufacturers.^3,6

S-adenosylmethionine (SAM-e) is another supplement with evidentiary support for use in osteoarthritis. In Europe, SAM-e has been used to treat arthritis for more than 30 years. It is a naturally occurring substance and should be dosed at 200 mg-1,600 mg per day. The exact recommended dosage continues to be a subject of debate and investigation.

Other supplements also can be useful in managing osteoarthritis pain. The Arthritis Foundation claims herbal supplements such as ginger, turmeric and cayenne red pepper may reduce pain and inflammation in patients with osteoarthritis.^3,6

Acupuncture can play a role in reducing osteoarthritis symptoms. T'ai chi may also be an effective adjunct in disease management, perhaps as a result of the stretching and strengthening performed during this exercise method.³  

Surgical Treatment
Surgical treatment for osteoarthritis is typically reserved for patients who have not responded to conservative treatment. Younger patients with knee osteoarthritis and an angular deformity may benefit from high tibial osteotomy. Femoral osteotomy may be indicated for young patients who have osteoarthritis at the hip. Both osteotomy procedures involve cutting and realigning the affected bone and joint in an attempt to reduce pain and improve functional ability. The goal of this intervention is to postpone total joint arthroplasty for as long as possible.^2-4,10

Arthroscopy allows the surgeon to lavage the joint and remove any loose fragments of bone or cartilage. Drilling of the chondral surface can stimulate fibrocartilage growth at the arthritic joint. Occasionally, a surgeon may graft autologous cultured chondrocytes in an attempt to repair small cartilage defects.^2,3,6

Joint arthrodesis or fusion is another option. Joints of the spine, wrist, fingers or toes are potential sites. Arthroplasty, or joint replacement, can restore some functional ability, improve quality of life and significantly reduce pain. Hips, shoulders, knees, ankles, elbows and lumbar discs are all potential joint replacement sites. Younger patients are not typically good candidates due to the long-term potential for implant failure and complexity of the surgery.^2,4,5,10,11

Michael Zychowicz is an adult nurse practitioner and RN first assistant at Orthopedics & Sports Medicine in New Windsor, NY. He has a doctorate in nursing practice and is an associate professor of nursing at Mount Saint Mary College in Newburgh, NY.