The American College of Rheumatology has published guidelines on the best treatment for arthritis pain, based on a review of the current evidence for osteoarthritis. Osteoarthritis is often called “wear and tear” of the cartilage — but it’s more complicated than that. Weight, genetics, and activity all contribute. So what actually works? This guide sets out the evidence, from the most effective first-line treatments to injections and surgery.
What is the best treatment for arthritis?
The American College of Rheumatology has published guidelines on the best treatment for arthritis pain, based on a review of the current evidence for osteoarthritis. Osteoarthritis is often called “wear and tear” of the cartilage — but it’s more complicated than that. Weight, genetics, and activity all contribute. So what actually works? This guide sets out the evidence, from the most effective first-line treatments to injections and surgery.
What is the best treatment for arthritis?
The single most effective treatment for arthritis pain is exercise. Two lifestyle measures — exercise and weight loss — outperform every drug and injection, and they have no side effects. Everything else is an addition to these, not a replacement.
Exercise: the best treatment for arthritis
The best treatment for arthritis pain is exercise, including aerobic activities such as walking, running, and cycling, as well as weight training. No single type is clearly better than another, but a few things improve the results:
- Strength gains matter. Programmes that achieve at least a 30% strength gain do better.
- Supervision helps. Supervised exercise is more effective than unsupervised.
- Tai Chi and yoga help too, with stronger evidence for Tai Chi.
Exercise works best for younger people (though older people benefit too), for mild to moderate arthritis (though even severe arthritis improves), especially for the knee, and when combined with weight loss and education.
Do I need intense workouts?
No. A study found that 20–30 minutes of exercise three times a week gave the same improvement in knee arthritis pain and function as 90 minutes three times a week — and people stuck to the shorter programme more reliably. A manageable routine you’ll actually keep to beats an ambitious one you won’t.
Weight loss and other lifestyle measures as best treatment for arthritis
Weight loss is powerfully effective: a 10% reduction in weight can halve the pain. Even small losses help, and can let some people avoid surgery.
Other measures that help — or don’t:
- Knee braces and hand splints help arthritis pain.
- Wearing flat shoes over high heels and walking on softer rather than rigid surfaces reduce joint load.
- APOS therapy — a shoe insert with rounded pods on the sole — has a NICE recommendation for severe knee arthritis, with improvements in pain and function compared with a sham device in a high-quality trial. The footwear and associated treatment cost around £875.
- Acupuncture, orthotics, massage, and laser are not effective, on current evidence.
Which medications are best for arthritis?
Diclofenac (Voltarol) and etoricoxib are the most effective painkillers for knee and hip arthritis — with etoricoxib less likely to cause stomach ulcers. Diclofenac gel is the most effective topical treatment for the knee. See our guide to how long anti-inflammatories take to work.
By contrast, opioids such as codeine and tramadol are ineffective and carry more side effects, and paracetamol is the least effective. For chronic pain, duloxetine can help. We don’t recommend fish oils or glucosamine, as the evidence is insufficient.
Do supplements help?
Some show promise for knee arthritis:
- Boswellia serrata (Indian frankincense) — its boswellic acids have anti-inflammatory effects, and some studies show reduced pain and stiffness. Typically 100–250 mg daily for four weeks.
- Curcumin (from turmeric) — anti-inflammatory through several pathways, and studies suggest it helps knee arthritis when taken for 12 weeks.
What about injections for arthritis?
We use injections when exercise, weight loss, and medication haven’t given enough relief.
The guidelines recommend cortisone injections, but the effect is short-lived, and there’s evidence cortisone may accelerate arthritis in some people. The same guidelines advise against hyaluronic acid and PRP — but they overlook more recent evidence supporting both for knee osteoarthritis:
- Hyaluronic acid—in high-molecular-weight gels such as Durolane—can outperform cortisone, anti-inflammatories, and exercise for knee arthritis, and around 65–70% of people respond.
- PRP (platelet-rich plasma) — over 20 randomised trials support it against cortisone, hyaluronic acid, or placebo, with around 65–70% responding. Higher-concentration options such as Arthrex ACP Max perform better.
- Arthrosamid — a non-degradable hydrogel for stubborn knee arthritis, with around 75–90% responding and relief lasting up to five years.
For a full head-to-head of the injection options, including how they compare and what they cost, see our guide to knee injections for arthritis. For the hip, see the injections for hip arthritis section.
When is surgery needed?
Surgery — usually joint replacement — is reserved for severe arthritis that hasn’t responded to the treatments above. Importantly, if you’re heading towards surgery, avoid a cortisone injection within about six months of it, as it raises the infection risk — see how soon after a cortisone shot you can have surgery.
Frequently asked questions about the best treatment for arthritis
What is the single best treatment for arthritis?
Exercise. It’s the most effective treatment for arthritis pain; it has no side effects, and it offers broader health benefits. Combined with weight loss where relevant, it outperforms every medication and injection — which are best thought of as additions when exercise and weight loss aren’t enough.
How much does losing weight actually help?
A great deal. A 10% reduction in body weight can roughly halve arthritis pain, and even modest weight loss helps — sometimes enough to delay or avoid surgery. It’s one of the most powerful things within your control.
What’s the best painkiller for arthritis?
For knee and hip arthritis, diclofenac and etoricoxib are the most effective, and diclofenac gel is the best topical option. Opioids and paracetamol are largely ineffective. Any anti-inflammatory should be used at the lowest effective dose, with an eye on the side effects.
Which injection is best for knee arthritis?
It depends on the knee. For lasting relief, high-molecular-weight hyaluronic acid (Durolane) and PRP each help about 65–70% of people, while Arthrosamid helps about 75–90% and lasts the longest. Our guide to knee injections for arthritis compares them directly.
Do supplements like turmeric work for arthritis?
There’s growing evidence that curcumin (from turmeric) and Boswellia serrata can reduce knee arthritis pain, taken over several weeks. They’re a reasonable addition for some people, though they don’t replace exercise and weight loss. Fish oils and glucosamine aren’t supported by good evidence.
Can arthritis be treated without surgery?
For most people, yes. The great majority of arthritis is managed with exercise, weight loss, medication, and — where needed — injections. Surgery is reserved for severe arthritis that hasn’t responded to these.
Final word from Sport Doctor London about the best treatment for arthritis
Exercise and weight loss are the most effective treatments for arthritis pain — with no side effects and benefits well beyond the joint. Where they aren’t enough, medications and injections such as Durolane, PRP, or Arthrosamid can be valuable additions, and surgery is reserved for severe, unresponsive cases.
If you have arthritis and want a treatment plan tailored to you, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
Thank you kind doctor. I am always trying to learn as much as I can about this painful condition