Care & Treatment
Effective treatment of your condition will probably involve a combination of medications and non-drug therapies. Physical activity is particularly important in many types of joint problems, especially in arthritis, and during rehabilitation after surgery.
The following types of medication are used to treat joint problems:
- Pain medications such as non-prescription acetaminophen (Tylenol®) or prescription medications including tramadol, tapentadol, or opioids containing oxycodone or hydrocodone.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) which are used both for pain and to reduce swelling. Non-prescription and prescription NSAIDs include aspirin, ibuprofen, and naproxen. NSAIDs can be used for a flare-up of osteoarthritis, but they should be used at the lowest effective dose and for as brief a time as possible.
- Topical medications, including creams, gels, or ointments that may contain an NSAID, or substances such as menthol or capsaicin (an extract of hot peppers).
- Anti-immune system medications such as DMARDs (disease modifying anti-rheumatic drugs). Examples are methotrexate, leflunomide (Arava®), sulfasalazine (Azulfidine®), and minocycline. If you are prescribed methotrexate, ask your healthcare provider about taking folic acid supplements daily.
- Genetically engineered “biologics” for autoimmune diseases such as rheumatoid arthritis. Examples are etanercept (Enbrel®), adalimumab (Humira®), and infliximab (Remicade®). These are given by injection or IV infusion and are generally reserved for patients for whom oral DMARD therapy has not been effective. You will need to be carefully monitored when taking these medicines, since they may increase your risk of infections or cancer.
- Corticosteroids (such as prednisone and cortisone) reduce swelling and suppress the immune system. They may be taken orally or injected into the affected area. Side effects of long-term use include infections, ligament weakness, and bone loss.
- Antidepressants are sometimes helpful for conditions such as fibromyalgia.
- Muscle relaxants may be useful in some cases.
NSAIDs can sometimes cause stomach irritation and even internal bleeding, so follow your healthcare provider’s instructions exactly.
Acetaminophen overdose can severely damage the kidneys or liver, particularly in older people. Dosages should be lowered in the older adult population.
Exercise strengthens weakened muscles and moves the joints. This will help improve function and reduce your pain. The earlier you get started, the better. Depending on your diagnosis, therapy may have to be done for a few weeks, or for many months. Exercise programs should be individually designed for you at the correct intensity by a physical therapist. These can include:
- Swimming (especially good for arthritis of the hip)
- Individualized exercises to do at home, including stretching and resistance training
- Yoga and tai chi (exercise programs that use stretching, slow movements, and balance)
Other ways you can reduce symptoms and improve function:
- Lose weight
- Apply heating pads or ice packs a couple of times a day (maximum of 20 minutes for each application). Make sure that the heating pad is not burning the skin.
- Wear splints or braces if recommended by your healthcare provider
- Use aids or devices (such as a cane or modified shoes) to help you keep your weight off an affected hip, knee, or other weight-bearing joint
- Rest: stop or modify any repeated movements that may cause or worsen your condition
- Get further education about the condition and cognitive behavioral therapy. This is particularly effective for fibromyalgia
Possible treatments include:
- Hyaluronic acid injections for knee arthritis (although the effectiveness of this treatment is debated, these work for some people and do not have many adverse effects)
Promising alternative or complementary approaches:
- Chiropractic treatments by a licensed practitioner (although studies in people over 65 are limited)
Note that some alternative or complementary techniques have no proven benefits (such as copper bracelets).
For some people, physiotherapy and pain medicines are not enough. Depending on your general health and your specific disability, your doctor may suggest surgery and referral to an orthopedic surgeon after carefully weighing risks and benefits. Five common types of surgery are:
If your joint problems are located in small bones such as those in your fingers, wrist, ankles, or spine, your surgeon may recommend joint fusion. In this operation, the ends of the bones in the affected joint are removed and the two bones are fused together. The joint can no longer bend after fusion surgery, since the connection will be rigid, but the pain and deformity will improve.
Larger joints can often be partially or completely replaced. The most common joint replacement surgeries are for the knee and hip. Joint replacement relieves pain and can let you move easily again. The improvement generally lasts for 10 to 15 years. If your pain is keeping you up at night or preventing you from taking even a short walk, surgery may be what you need.
Having a joint replaced is major surgery. Age alone does not determine eligibility. Excellent results can be achieved even in patients over 80 years old, if they are in good enough health to withstand the operation and undergo a few weeks or months of physiotherapy afterward (often in a rehabilitation facility and continuing as an outpatient). Sometimes therapy will be done in your home. Exercising as well as you can before the surgery will strengthen your muscles and help you have a speedier rehabilitation and recovery.
Arthroscopic Knee Surgery
In some cases, knee disabilities like locking, swelling, weakness, and pain are the result of damaged cartilage in the joint. A relatively simple day procedure with minimal anesthesia and home rehabilitation may be all that you need. In an arthroscopic procedure, only a couple of tiny incisions are necessary and the surgical instruments, with a camera, are threaded into the knee with virtually no damage to nearby tissues.
Rotator Cuff or Frozen Shoulder Repair
If you have a major tear in some component of the rotator cuff, or if your shoulder is frozen, and you have tried rest and physiotherapy without improvement, your healthcare provider may decide to refer you to a surgeon for surgical repair of the damaged tissue.
The role of rehabilitation is:
- to get you back to at least your prior level of physical function
- to allow you to return home or to your previous residence as soon as possible
If you have had surgery, you may need to recuperate afterward in a rehabilitation facility of some kind. This depends on the surgery you have undergone, your health, and the availability of caregivers and a supportive environment at home. People who have had hip or knee replacements almost always spend at least some time in a rehabilitation center before returning home.
Different types of rehab facilities include:
- acute (hospital) or subacute rehabilitation centers
- nursing homes
- skilled nursing facilities
- home care
In acute and sub-acute care rehab centers, you will receive at least 3 hours of rehabilitation per day 5 days per week. The team of healthcare professionals includes physical therapists, occupational therapists, rehab nurses, social workers, physiatrists, and others if needed. Nursing homes and skilled nursing facilities provide therapy as well, but the intensity and number of hours of rehabilitation are usually lower. Home care may be used after some time in a rehabilitation residence, or if your healthcare provider feels that a rehab facility is not needed in your case. The home care nurse will schedule visits from a physical therapist, occupational therapist, social worker, and any other healthcare professional considered necessary.
If you have osteoarthritis in your knees or hips, you should be checked at least once a year by your healthcare provider to assess your ability to carry out daily functions and to make sure your pain is well controlled.
Other joint problems need to be evaluated periodically as well, especially since ignoring pain or other symptoms may cause irreparable damage that could have been avoided.
Last Updated June 2020