Osteoarthritis

Learn about Osteoarthritis, what treatments are available and get helpful tips on management

Last updated: 29 February 2020 · 10 min read

painHEALTH - Osteoarthritis knee pain

The Osteoarthritis Research Society International (OARSI) defines the condition as:

“Osteoarthritis is a disorder that can affect any moveable joint of the body, for example knees, hips, and hands. It can show itself as a breakdown of tissues and abnormal changes to cell structures of joints, which can be initiated by injury. As the joint tries to repair, it can lead to other problems.

Osteoarthritis first shows itself as a change to the biological processes within a joint, followed by abnormal changes to the joint, such as the breakdown of cartilage, bone reshaping, bony lumps, joint inflammation, and loss of joint function. This can result in pain, stiffness and loss of movement.

There are certain factors which make some people more vulnerable to developing osteoarthritis, such as genetic factors, other joint disorders (such as rheumatoid arthritis), injury to the joint from accidents or surgery, being overweight or doing heavy physical activity in some sports or a person’s job”

Research User Group, Institute of Primary Care and Health Sciences, Keele University, UK1

Facts and myths

FACT: Osteoarthritis is more common as you age, however it can and does affect younger people as well. This is especially so for those who may have suffered a joint injury in the past.

FACT: Improvement in pain and disability can happen over time, particularly for OA of the knees and fingers. It is important to understand the positive, active things you can do to help with the pain associated with OA.

FACT: Symptoms (including pain) are NOT strongly related to the structural joint changes seen on x-rays or scans. This means that relying on information from scans alone can be unhelpful.

MYTH: A common myth is that OA worsens over time, no matter what you do. This is not true. OA is not an inevitable part of ageing. OA is a process of attempted repair: the current science suggests this repair process may limit joint damage and symptoms.

What are the causes of OA?

The exact causes of OA are still unclear. There are a number of factors that can contribute to the development of OA including:

  • Being overweight or obese
  • Having previous joint injury, joint surgery and/or history of overuse of the joint (e.g. jobs involving repetitive lifting of heavy loads, kneeling, squatting, use of the hands)
  • Your genetics (e.g. a family history of OA)

What are the symptoms of OA?

Osteoarthritis affects people in different ways and symptoms can vary depending on which joint is affected.

Symptoms often develop slowly over time but can become persistent in later stages of OA, especially pain. You can also experience periods of more severe pain, followed by periods where you experience less pain or are pain-free.

We know from science that factors such as low mood, increased stress, over-activity, illness and/or other health conditions can contribute to pain flares or fluctuations. Many of these factors are modifiable –this means these factors can be managed (by you with the support of your health team) to improve your function and pain.

Symptoms of OA include:

  • Joint pain and stiffness that is aggravated by too much or too little movement/exercise/activity.
  • Functional limitations made worse by muscle weakness and/or joint instability.
  • Reduced quality of life.

How is OA diagnosed?

Osteoarthritis can be diagnosed from a clinical examination without the need for any special tests or x-rays if a person:2

  • Is aged 45 years or older
  • Has joint pain related to activity or movement
  • Has morning stiffness that lasts for less than 30 minutes.

X-rays, scans or blood tests are only required if the doctor needs to rule out other causes of your joint pain. Importantly, these tests do not show pain, nor are they helpful in determining the best management for you.

What treatments are best for managing OA?

Osteoarthritis, as a chronic condition, requires holistic care2-4. A holistic “whole person” approach to care means both you and your health professionals) working together to design a management plan tailored to your unique needs and preferences. See the right care for OA fact sheet.

If you have osteoarthritis, you may have other chronic conditions, such as cardiovascular disease or diabetes. It is also common to experience depression, anxiety and/or feel socially isolated. When you work with your health professional, it is important your tailored plan addresses all these factors, so you get the best possible outcome. Your management plan should also consider your family, social, and occupational needs.

A management plan that emphasises the simple, safe and low cost options is typically best. There are three core components of best management of OA 3-5, including:

  1. Information and education about OA
    • Learn about the condition and understand what treatments are the most effective.
  2. Physical activity and exercise
    • Regular activity/exercise helps relieve symptoms and improves function and has multiple positive benefits for other body systems and mood.
  3. Weight loss for people who are overweight/obese

For more information about these components of care, download the fact sheet on right care for OA and see the ‘Helpful tips’ section below.

In  addition to the core treatments outlined above, other ‘adjunctive’ treatments that may be helpful for some people, include3-4:

  • Heat (such as heat packs or hot water bottles)
  • Cognitive behavioural therapy (strategies to support helpful thinking about pain and your habits when you have pain), particularly in combination with exercise
  • A short course of manual therapy (such as joint mobilisation or massage)
  • Transcutaneous electrical stimulation (TENS) units (for use at home)
  • Assistive devices (such as tap turners, walking sticks and others)
  • Some medications (see next section below)

There are some treatments that are NOT recommended for OA, 3,4 This is because there is either no evidence that they are beneficial, or evidence is that they have only small or no benefits, or because their potential harms may outweigh any benefits. These include:

  • Acupuncture,
  • Ultrasound therapy,
  • Shockwave therapy,
  • Laser therapy,
  • Cold therapy,
  • Orthopaedic footwear, insoles and knee braces,
  • Kinesio taping,
  • Glucosamine,
  • Stem cell therapy,
  • Opioid medications,
  • Platelet rich plasma (PRP) therapy.

What is the role of medications in managing pain associated with OA?

Medications cannot change the underlying OA disease process. Although some medications may assist with pain relief of OA, medicines are not a ‘cure’. Medications provide a ‘therapeutic window’ to allow you to stay active, to stay engaged at work and at home, to exercise regularly and to address weight loss.

Current guidelines recommend that oral and topical (applied to the skin) nonsteroidal anti-inflammatories (NSAIDs) may be helpful. 3,4 See our medicines and procedures pain management module. Topical NSAIDs may be tried first, and if these are insufficient for pain relief then oral NSAIDs or cyclooxygenase-2 (COX-2) inhibitors may be considered. These oral medications should be used at the lowest effective dose for the shortest period of time due to the risk of gastrointestinal side effects. Whenever oral NSAIDs or COX-2 inhibitors are used, they should be co-prescribed with cover from a medication that helps protect the stomach from side effects (called a proton pump inhibitor).

Although paracetamol (or panadol osteo) has long been considered a standard treatment for OA, the most recent scientific evidence3,4 suggests that benefits of paracetamol are too small to be of any clinical value. Their use may be associated with infrequent side effects if used at excessive doses, or with long-term regular use. If required, paracetamol should be used, at the lowest effective dose and for the shortest possible time.

For people with moderate to severe OA pain, corticosteroid injections can be considered for short-term relief of pain. Care should be taken with repeated injections due to potential for harm. There is debate over the role of hyaluronan (Synvisc) injections,3,4 however Australian guidelines4 do not recommended them for hip or knee OA as these are generally not effective, based on current evidence.

Opioid medications, taken either orally or via patches (transdermal) are strongly NOT recommended3,4 for treatment of OA pain. This is because of the very high risk of dependency and other harmful side effects.

What is the role of surgery in managing OA?

For many people, surgical procedures are not necessary, and may not always be helpful. In some cases, surgical procedures can play an important role in the treatment of OA. People who may benefit from joint surgery include:

  • those who experience joint symptoms (pain, stiffness and reduced function) that have a profound impact on quality of life AND;
  • those who have tried (and persisted with) the best non-surgical treatments (e.g.; exercise, weight loss) for OA and have not experienced any improvement.

Scientific evidence suggests that these people should be referred to an orthopaedic surgeon (bone doctor) for consideration for joint surgery. The types of surgery that may be useful include joint replacement (arthroplasty), joint fusion (arthrodesis) or joint repositioning (osteotomy).

Arthroscopy is not recommended for knee OA unless a person has a clear history of mechanical knee locking.2,4Although key hole surgery (arthroscopy) is often thought to be beneficial for knee OA, the most recent scientific evidence suggests that these types of procedures offer little benefit for knee OA and are associated with side effects.6

Helpful tips to manage OA

  • • Learn as much as you can about your condition and play an active part in treatment decisions with your healthcare team: you are the team leader. Asking your family or friends for help where possible can benefit you, as well as help them to understand your pain experience. Take a look at our making sense of pain management module.
  • Undertake regular structured exercise that includes a muscle strengthening program on 2-3 days/week. This may be a home-based or gym-based program, or a group class run by a health professional or fitness trainer. A physiotherapist, exercise physiologist or personal trainer can help you develop a personalised exercise programme tailored to your needs. See our movement with pain management module.
  • Try and aim for 30 mins of moderate intensity aerobic physical activity on 5 days/week. Physical activity can be undertaken in bouts of 10 mins to accumulate towards the total of 30 minutes. Choose physical activities that you enjoy and that can be easily incorporated into your daily and weekly routines. Try and reduce the amount of time you spend sedentary over the course of the day, as being sedentary can impair your physical function, irrespective of whether you accumulate the desired amount of physical activity each day/week.
  • Try and manage your body weight and maintain a healthy diet. Your health professional can advise you on the best strategies for weight loss if you are overweight or obese. For people who are overweight or obese, a minimum weight loss target of 7.5% of body weight is recommended. Weight loss combined with exercise achieves the best benefits. For people with a healthy body weight, healthy eating (see resources below) is essential to maintain a healthy body weight and prevent future weight gain.
  • Ask your doctor or your pharmacist about what medicines may be right for you and how best to use them. You can check out our medicines and procedures pain management module.
  • Learn about other strategies to self-manage your pain including heat, rest, relaxation: see our mindfulness meditation pain management module and our yoga pain management module.
  • Counsellors and/or psychologists can help you with cognitive behavioural strategies to teach you how to better cope with your pain. There are also online programs that you can undertake independently at home (see resources below).
  • Try and pace your activities: do little bits often. This involves planning and organising your activities, and your day, to avoid pain flares and keep you active and doing the things that are important to you. See the pacing and goal setting pain management module.
  • Gentle stretching and relaxation are often useful options, including changing positions frequently rather than staying in the one position for extended periods.
  • Modifications to everyday equipment can reduce stress on joints. Raising the height of a chair to make standing and sitting easier, or using a smaller saucepan that is not as heavy to avoid joint strain, can be helpful.

Want more information?

For more information about Osteoarthritis, go to Arthritis Australia, the Australian Rheumatology Association, the WA Elective Joint Replacement Service Model of Care or Cochrane Summaries.

Another reliable, evidence-informed resource for OA is My Joint Pain. You can also find links to Further Assistance.

If you’re experiencing osteoarthritis or are concerned about your osteoarthritis, we recommend the our Medical Self-Check.

Movement with pain

Pacing and goal setting

Approaching pain

Osteoarthritis: Promoting wise healthcare

Physical activity

Dealing with pain

Healthy eating and Arthritis

My Joint Pain - Physical Activity

  1. Blackburn S, Research User G, Rhodes C, Higginbottom A, Dziedzic K. The OARSI standardised definition of osteoarthritis: A lay version. Osteoarthritis Cartilage 2016;24:S192. [PDF]
  2. National Clinical Guideline Centre. Osteoarthritis. Care and management in adults. Clinical guideline CG177. Methods, evidence and recommendations. London; National Institute for Health and Care Excellence 2014. [PDF]
  3. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27:1578-89.[PubMed]
  4. The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd East Melbourne, Vic: RACGP, 2018. [PDF]
  5. Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77:1251-60. [PDF]
  6. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747. [PubMed]

This module has been developed by Rana Hinman, BPhysio(Hons), PhD, Professor, NHMRC Senior Research Fellow, The University of Melbourne, Australia; Andrew Briggs, BSc(PT) Hons; PhD; FACP, Professor, School of Physiotherapy and Exercise Science, Curtin University, Perth Australia; and Helen Slater, PhD, FACP, Professor, School of Physiotherapy and Exercise Science, Curtin University, Perth Australia.

The information in this module is based on current best evidence research and clinical practice


SHARE THIS ARTICLE