What treatments are there for osteoarthritis of the knee?

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There’s no cure for osteoarthritis as yet, but there are a number of treatments that can help ease symptoms and reduce the chances of your arthritis becoming worse.

Drugs for osteoarthritis of the knee

Painkillers (analgesics) help with pain and stiffness but they don’t affect the arthritis itself and won’t repair the damage to your joint.

  • Painkillers are best used occasionally when you’re in pain or when you’re likely to be exercising.
  • Paracetamol is usually the best and most well-tolerated painkiller, but make sure you take the right dose because many people take too little – try 1 g (usually 2 tablets) 3 or 4 times a day. You can buy them from your chemist or supermarket.
  • Combined painkillers (e.g. co-codamol, co-dydramol) contain paracetamol and a second codeine-like drug, so they may be helpful for more severe pain. Because they’re stronger than painkillers, they’re more likely to cause side-effects such as dizziness and constipation.

Non-steroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen or naproxen, may be recommended if inflammation is contributing to your pain and stiffness.

  • NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these. They may suggest the lowest effective dose for the shortest possible time and prescribe another drug called a proton pump inhibitor to help protect your stomach from digestive problems.
  • NSAIDs also carry a slightly increased risk of a heart attack or stroke, so your doctor will be cautious about prescribing them if there are other factors that increase your overall risk (e.g. you smoke or you have circulation problems, diabetes, high blood pressure or high cholesterol).

Non-steroidal anti-inflammatory creams and gels are a good option if you have trouble taking NSAID tablets.

  • Creams and gels can be applied directly onto painful joints three times a day and there’s no need to rub them in – they absorb through your skin on their own.
  • They’re extremely well tolerated because very little is absorbed into your bloodstream.
  • You can tell within a few days whether they’ll help with your pain.

Capsaicin cream is made from the pepper plant (capsicum) and is an effective and well-tolerated painkiller.

  • Capsaicin cream is only available on prescription and needs to be applied three times a day.
  • Most people feel a warming or burning sensation when they first use it, but this generally wears off after several days.
  • The pain relief starts after a few days and you should try it for at least two weeks before deciding if it’s helped.

Stronger painkillers, for example opioids/anti-inflammatories, may be prescribed if you have severe pain and other medications don’t work well enough.

  • Stronger painkillers are more likely to have side-effects, especially nausea, dizziness and confusion, so you’ll need to see your doctor regularly and report any problems.
  • Some opioids can be given as a plaster patch to wear on your skin, which can give pain relief for a number of days.
  • Stronger painkillers are only available on prescription.

Because these treatments work in different ways, you can combine them for greater pain relief. Ask your chemist or doctor for advice on safe combinations.

If you have trouble opening childproof containers, ask the pharmacist to put your drugs in a more suitable container. You can also order a child-resistant closure card.

Steroid injections are sometimes given directly into a particularly painful knee joint.

  • The injections can start working within a day or so and may improve pain for several weeks or months.
  • They’re mainly used for very painful osteoarthritis, for sudden attacks caused by shedding calcium crystals and to help you through important events (such as a family wedding).

Arthritis Research UK have also recently awarded a grant for the PROMOTE trial, a study into whether methotrexate, a drug commonly used to treat rheumatoid arthritis, can be used to treat osteoarthritis of the knee. Another trial is looking into whether a drug called spironolactone is an effective treatment.

Other treatments for osteoarthritis of the knee

Applying warmth or cold to your knee can relieve pain and stiffness.

  • Heat lamps are popular, but a hot-water bottle or reheatable pad (available from most chemists) are just as effective.
  • An ice pack can also ease pain.
  • Don’t apply a hot or cold pad directly onto the skin.

Hyaluronic acid injections, which help to lubricate your knee joint, are sometimes given when steroid injections don’t work.

  • You may be given a single injection or a course of several injections.
  • This form of treatment isn’t approved by the National Institute for Health and Clinical Excellence (NICE) and isn’t widely used because the evidence that it works isn’t convincing.

Transcutaneous electrical nerve stimulation (TENS) can be used for pain relief, although research evidence suggests that it doesn’t work for everyone.

  • A TENS machine is a small electronic device that sends pulses to the nerve endings via pads placed on the skin. The device produces a tingling sensation which is thought to modify the pain messages sent to the brain.
  • TENS machines are available from pharmacies and other major stores, but a physiotherapist may be able to loan you one to try before you decide to buy one.

Knee braces are becoming more popular and more evidence to support their use for osteoarthritis is becoming available.

  • There are several types that can help to stabilise the kneecap and make it move correctly.
  • You can buy knee braces from sports shops and chemists, but you should speak to your doctor or physiotherapist first. They may also be able to provide braces or recommend the best ones for you.

Surgery may be recommended if you have severe pain or mobility problems.

  • knee replacement operation can give substantial pain relief in cases where other treatments haven’t helped enough. Replacements now last on average over 15 years.
  • If your knee locks, an operation to wash out loose fragments of bone and other tissue from the joint can be performed – this is called arthroscopic lavage.
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