Osteoarthritis Treatment: Complete Guide to Non-Drug, Pharmacologic, Surgical & Regenerative Options

Non-Pharmacologic (Core for All Patients)

• Weight management (1 lb loss = 4 lb knee load reduction)
• Exercise: aerobic + neuromuscular + strength (OARSI strongly recommends)
• PT/OT: joint protection, assistive devices (cane, jar openers), home modification
• Self-management education programs

Pharmacologic

Class	Examples	Role	Cautions
Oral analgesics	Acetaminophen, NSAIDs (ibuprofen, naproxen, celecoxib)	First-line pain relief	GI, CV, renal risk; use lowest effective dose
Topical	Diclofenac gel, capsaicin, lidocaine patch	Knee/hand OA; minimal systemic absorption	Local irritation
Intra-articular	Corticosteroids (q3–4 mo), hyaluronic acid (controversial)	Flare control; HA modest benefit	Cartilage toxicity with frequent steroids
Duloxetine	SNRI	Chronic pain central sensitization	Nausea, CYP interactions
Opioids	Tramadol, hydrocodone	Last resort, short-term	Addiction, falls, constipation
Supplements	Glucosamine/chondroitin (mixed evidence), curcumin, Boswellia	Adjunct; choose USP-verified	Drug interactions (warfarin)

Surgical

• Arthroscopy (mechanical symptoms only; not for pure OA)
• Osteotomy (young, unicompartmental, malaligned)
• Partial/total joint replacement (end-stage, failed conservative)

Regenerative (Emerging)

• PRP: autologous platelets → growth factors; modest pain improvement in knee OA (level II evidence).
• MSC (stem cell): not FDA-approved for OA; clinical trials only. Beware direct-to-consumer clinics.

Step-wise, multimodal approach tailored to joint, severity, comorbidities, and patient goals.