Learn about Osteoarthritis, what treatments are available and get helpful tips to form part your co-management treatment plan

painHEALTH - Osteoarthritis knee pain

Osteoarthritis (OA) is a chronic condition that can affect one or more joints. It is the most common form of arthritis and one of the most frequent causes of musculoskeletal pain. OA should not be confused with osteoporosis. In joints without OA, articular cartilage covers the bone ends to allow the joint to move easily and to cushion the bones. OA occurs when the cartilage becomes more brittle and gradually thins or wears away. Over time, increased pressure on the bones may cause bony spurs called osteophytes to form around the edges of the joint. Osteoarthritis affects the whole joint including cartilage, bone, ligaments and muscles. It can occur in any joint but the hips, knees, the big toe and small joints in the hand are most often affected. Whether or not you experience pain with OA is not well correlated with the degree of change in the joints.

OA 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. A common misconception is that OA inevitably worsens over time. In fact, the process underpinning OA is one of attempted repair: the repair process may limit joint damage and symptoms in many people. 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.

What are the causes of OA?

The exact causes of OA are still unclear. However, there are a number of factors that are known to contribute to the development of OA. These include:

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

What are the symptoms of OA?

Osteoarthritis affects people in different ways and the symptoms can vary according to which joint is affected. OA is usually characterised by joint pain that is aggravated by too much or too little movement, and by stiffness, especially if you limit your activities too much. OA is associated with functional limitations that are often associated with pain and can lead to reduced quality of life. Symptoms often develop slowly over time, but can become constant in later stages of OA disease, especially pain.

How is OA diagnosed?

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

  • aged 45 or over
  • has joint pain related to activity or movement and
  • has either no joint stiffness or any morning stiffness that lasts for less than 30 minutes1.

X-rays, MRI scans or blood tests are only needed if the doctor needs to rule out other causes of your joint pain. Although x-rays and MRI scans can show changes in the bone and/or cartilage of your joint, these changes are not a good indicator of how severe the pain and other symptoms may be. These tests cannot show pain, nor are they helpful in determining the best management.

What treatments are best for managing OA?

Osteoarthritis is a chronic condition that requires a self-management approach within the context of holistic care1. A holistic “whole person” approach to co-care (you and your health professionals) means that an OA management plan is tailored to your unique requirements and preferences.

Osteoarthritis often co-exists with other chronic conditions associated with ageing and obesity, such as cardiovascular disease and diabetes, and other psychosocial factors such as depression, anxiety and/or social isolation. Factors such as family, social and occupational needs in addition to the joint symptoms related to OA are also important as part of your management plan.

A good management plan for OA must be about your goals and needs: what you can do and what your health team can help you with. A management plan that emphasises non-drug and non-surgical treatments is best: scientific research1 shows that there are three core components to best management of OA.

  1. access to appropriate information about OA- to increase understanding about OA, its management, to counter common misconceptions about the condition. Common misconceptions include that OA will inevitably get worse over time, and that OA cannot be treated, or that surgery will ‘cure it’.
  2. physical activity and exercise, regardless of age, comorbidities, pain severity and disability. This should include aerobic fitness exercise that is good for general health (heart, body, mood) and exercise that is specific for strengthening the muscles supporting and moving the affected joints.
  3. treatments to achieve weight loss for people who are overweight or obese

Additional (‘adjunctive’) treatments such as the use of heat and cold, joint manipulation and stretching, transcutaneous electrical stimulation (TENS), braces and foot orthotics and assistive devices (such as tap turners, walking sticks and others), may also be appropriate additions to the above components of care, but have less well proven benefit and/or offer less symptom relief.

Acupuncture and glucosamine are not recommended for the management of OA as scientific evidence shows they provide little or no benefit: any benefit may be limited to placebo effects1.

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

Medications cannot change the underlying OA disease process. What medications can do is to assist in pain relief of OA, but 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 scientific evidence suggests that simple analgesia may be helpful. This can include non-steroidal anti-inflammatories (NSAIDs) and paracetamol. See our medicines and procedures pain management module. Topical NSAIDs should always be used first, and only if these are insufficient for pain relief should oral NSAIDs or cyclooxygenase-2 (COX-2) inhibitors 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). The most recent scientific evidence suggests that paracetamol (or panadol osteo) offers only minimal short-term benefit for OA and may be associated with harmful side effects to the liver and gastrointestinal system 2,3. 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. Hyaluronan injections are not recommended for OA as these are generally not effective.

What is the role of surgery in managing OA?

In some cases, surgical procedures can play a role in the treatment of OA but are not necessary for many people, and may not always be helpful. 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 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). Although 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 effects4. Arthroscopy is not recommended for knee OA unless a person has a clear history of mechanical knee locking1.

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 help you, as well as help them to understand your pain experience. Take a look at our making sense of pain pain management module
  • having a good understanding of OA pain and disability will give you the confidence to manage your condition successfully, help you to ask the right questions of your healthcare providers and address unhelpful thoughts and beliefs about the future
  • exercise everyday, even if only a short walk. This helps manage pain and improve your function. Choose exercise that you enjoy and that can be easily incorporated into your daily and weekly routines. Aim for a mixture of strengthening exercises and general aerobic activity. Exercise is good for your general well being (mind and body; heart and lungs), your mood, your joints and muscles, your balance and your bone health. A physiotherapist, exercise physiologist or personal trainer can help you develop a personalised exercise programme. See our movement with pain management module.
  • manage your body weight and have a healthy diet. Your doctor and /or a dietician can advise you on the best strategies for weight loss if you are overweight or obese.
  • 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 other strategies to self-manage your pain including heat, cold, rest, relaxation and avoidance of aggravating activities: see our mindfulness meditation pain management module and our yoga pain management module
  • pace your activities: do little bits often. This involves planning and organising your activities 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
  • try and use normal movement for everyday activities like lifting, sitting, standing, bending and reaching. When you have pain, sometimes its easy to forget how to move normally or to use abnormal movements to protect the joint but that ultimately can make pain worse. Check out our movement with pain management module
  • good posture can help reduce pain and improve function. 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. A good example is 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.

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 settings

Approaching Pain

Physical Activity

Dealing with pain

Health eating and Arthritis

My Joint Pain - Physical Activity

  1. 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]
  2. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. Mar 2014;22(3):363-388. [PubMed]
  3. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225. [PubMed]
  4. 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 A/Prof Rana Hinman, BPhysio(Hons), PhD Australian Research Council Future Fellow, The University of Melbourne, and Helen Slater, PhD, FACP, Associate 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.