How to Treat Degenerative Arthritis

Degenerative joint disease—commonly known as osteoarthritis—is the most prevalent form of arthritis worldwide. It is characterized by progressive breakdown of articular cartilage, underlying bone remodeling, synovial inflammation, and associated structural changes in ligaments and periarticular tissues. While there is no cure, evidence-based management focuses on symptom control, functional preservation, and slowing disease progression.

First-line treatment emphasizes nonpharmacologic interventions. Weight management is critical for weight-bearing joints: even modest weight loss (5–10% of body weight) significantly reduces mechanical stress on knees and hips and improves pain and mobility. Structured, low-impact exercise—including aerobic activity, resistance training, and neuromuscular conditioning—enhances joint stability, muscle strength, and proprioception. Physical therapy programs tailored to individual needs are strongly recommended, particularly for patients with functional limitations or gait abnormalities.

Pharmacologic options begin with topical nonsteroidal anti-inflammatory drugs (NSAIDs) for localized knee or hand osteoarthritis, offering efficacy with lower systemic exposure. Oral NSAIDs may be used short-term for moderate-to-severe pain but require careful risk assessment—especially in older adults or those with cardiovascular, gastrointestinal, or renal comorbidities. Acetaminophen has limited utility and is no longer routinely recommended due to marginal benefit and potential hepatotoxicity at higher doses.

Intra-articular corticosteroid injections provide transient relief—typically lasting 4 to 12 weeks—and are appropriate for acute inflammatory flares. Hyaluronic acid injections remain controversial; current guidelines do not endorse them for routine use due to inconsistent clinical trial data and modest effect sizes. Emerging therapies such as intra-articular platelet-rich plasma (PRP) show promise in select patients, though robust long-term evidence is still evolving.

For advanced disease unresponsive to conservative measures, surgical referral is warranted. Total joint arthroplasty—particularly of the hip or knee—offers durable pain relief and functional restoration with high patient satisfaction rates. Joint-preserving procedures like osteotomy or unicompartmental arthroplasty may be considered in younger, active individuals with focal, asymmetric involvement.

Management must be individualized, integrating patient goals, comorbidities, joint distribution, and psychosocial factors. Shared decision-making, regular reassessment, and multidisciplinary coordination—including input from rheumatologists, physiatrists, physical therapists, and orthopedic surgeons—are essential components of optimal care.