The American College of Rheumatologists has released guidelines for the best treatment for arthritis pain. These recommendations are based on a review of current evidence for the treatment of osteoarthritis. Osteoarthritis is a form of joint disease referred to as ‘wear and tear of the cartilage, but it’s a little bit more complicated than that. Other factors, such as weight, genes, and exercise, can contribute to the development of osteoarthritis.

Treatment of Arthritis: What is Effective?  

Can physical therapy help arthritis?   

Firstly, the best treatment for arthritis pain is exercise. This exercise should include aerobic activities such as walking, running, cycling, and weight training. There is not enough evidence to recommend one form of exercise over another. However, exercise programs that get strength gains of at least 30% do better. Also, supervised exercise is more effective. There is less evidence that balance exercises are better. But it makes sense to add this to a program. Other proper forms of exercise include Tai Chi and Yoga, with more evidence for Tai Chi.

Recent evidence has found that exercise for arthritis works best for the following:

  • Younger people, although older people also benefit a little less.
  • People with mild to moderate arthritis. However, even in severe arthritis, exercise improves symptoms.
  • Knee arthritis. Over 50 studies show that exercise is the best treatment for knee arthritis, compared to 12 for hip arthritis.
  • People combine exercise with other lifestyle factors, such as weight loss and education on arthritis.

Are low-intensity workouts as good as high-intensity workouts for knee arthritis?

We think so. A recent study found that 20-30 minutes of exercise three times a week produced the same benefits for pain and function in knee arthritis as 90 minutes three times a week. However, those in the low-intensity group were likelier to stick to their exercise programme. These results suggest that an exercise program that requires less time and fewer exercises can still offer benefits and may be easier for people to undertake and stick to than one that requires more time and effort.

Other effective treatments for arthritis

In addition to exercise, other factors play a role. For example, weight loss is effective for pain relief, with a 10% weight loss leading to a 50% reduction in pain. So, even small reductions in weight can reduce pain and help some people avoid surgery. Knee braces and hand splints also help with arthritis pain. However, other treatments such as acupuncture, orthotics, massage, and laser are ineffective. Different ways we can reduce pain include avoiding injury (from sports), walking on soft rather than rigid pavements, and wearing flat rather than high-heeled shoes (at least one study shows that high-heeled shoes change the forces on our joints and might make arthritis pain worse).

A new shoe insert called APOS therapy has recently gained NICE recommendations for treating severe knee arthritis. These shoes feature unique rounded pods on the undersurface. We think APOS therapy reduces knee pain by changing the forces on the foot and knee and correcting abnormal walking patterns. NICE highlighted that clinical evidence from a high-quality trial shows that a high-quality trial improves knee pain and function compared with a sham device. The cost for the footwear and associated treatment from trained professionals is estimated at £875 per person.

Yoga butt injury

Which Anti-Inflammatory Drugs are Best for Arthritis?  

A recent study found that Diclofenac (Voltarol) and Etoricoxib are the most effective pain killers for knee and hip arthritis. But etoricoxib is less likely to cause stomach ulcers. In addition, diclofenac gel is the most effective topical treatment for knee arthritis. However, opioids such as codeine or tramadol are ineffective and have an increased risk of side effects. Finally, paracetamol is the least effective for arthritis.

We do not recommend fish oils or glucosamine due to insufficient evidence.

It is worth noting that lifestyle treatments such as exercise, weight loss, and diet have no side effects and benefits beyond pain relief. Therefore, we should include these lifestyle factors in our treatment of arthritis.

Supplements 

There is increasing evidence that some supplements may improve knee arthritis pain:

Boswellia Serrata is a herb derived from the Indian frankincense tree. Boswellic acids inhibit 5-lipoxygenase, an enzyme with anti-inflammatory effects. In some studies, Boswellia serrata has been shown to reduce pain and stiffness in knee arthritis. We recommend 100-250mg daily for four weeks.

Curcumin is obtained from the Curcuma longa plant. Curcumin has anti-inflammatory effects through several pathways, including inhibition of inflammatory mediators such as the COX-2 enzyme. Studies suggest that Curcumin is effective for knee arthritis and should be taken for 12 weeks. 

What about injections for the treatment of arthritis?

Overall, we use injections to treat arthritis when other treatments are ineffective.

While the guidelines recommend cortisone injections, the pain-relieving effect is only short-acting. Also, there is some evidence that cortisone may accelerate arthritis in some people. There is a recommendation against other injections, such as hyaluronic acid or platelet-rich plasma. However, these guidelines ignore recent evidence on hyaluronic acid and platelet-rich plasma injections for knee osteoarthritis.

Evidence suggests that high-molecular-weight hyaluronic acid, such as Durolane, has a better effect on knee arthritis than other treatments, such as cortisone, anti-inflammatory medication, or exercise therapy.

Platelet-rich plasma injections improve pain associated with knee arthritis. Twenty-three randomised trials demonstrate the effectiveness of PRP compared with other injections, such as cortisone, hyaluronic acid, or placebo saline. We discuss the evidence for platelet-rich plasma injections in this blog.

Final word from Sportdoctorlondon about the best treatment for arthritis

All in all, exercise and weight loss are the most effective treatments for arthritis-related pain. In cases where pain relief is inadequate, medications and injections such as Durolane or PRP can be helpful additions.

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