Management of
osteoarthritis should be based on a combination of non-
drug and
drug treatments targeted towards prevention, modifying risk and
disease progression.
Obesity is the most important modifiable risk factor, so losing weight in addition to land- and water-based exercise and
strength training is important. While
paracetamol can be tried, guidelines recommend non-steroidal anti-inflammatory drugs as first-line treatment for
osteoarthritis. If there are concerns about the adverse effects of oral treatment, particularly in older patients or those with comorbidities, topical non-steroidal anti-inflammatory drugs can be used.
Glucosamine does not appear to be any better than placebo for
pain. Its effect on the structural progression of disease when taken alone or in combination with
chondroitin is uncertain.
Fish oil has not been found to reduce the structural progression of knee
arthritis. Surgical interventions should be avoided in the first instance, with arthroscopic procedures not showing benefit over
sham procedures or optimised physical and medical
therapy.
Joint replacement surgery should be considered for severe
osteoarthritis.