Non-operative intervention of arthritic or injured joints can relieve pain and maintain or restore function.

There are many treatments to try before opting for joint replacement surgery, considered a last resort but also a highly successful one.

Health and behavior modification

Sometimes the simplest answer is the best.  You can often gain relief from joint pain, inflammation and stiffness through these techniques:

• exercise / physical therapy
• avoiding activities that cause stress or strain
• weight loss
• wearing a supportive brace

Drug treatments

Medications available to treat joint problems run the gamut, from plain aspirin to complex prescription-only drugs.  Major drug categories include:

• acetaminophens, such as pain relievers like Anacin-3 and Tylenol for mild symptoms
• traditional NSAIDs (non-steroidal anti-inflammatory drugs) are for moderate to more severe pain come in prescription and over-the-counter strengths, with names like Advil, Nuprin and Aleve
• Cox-2 inhibitors, for moderate to more severe pain, ease symptoms without the stomach upset from traditional NSAIDs, but some (Vioxx, Bextra, Celebrex) can increase the risk of heart attack or other cardiovascular problems
• opiate and oxycodone drugs might be prescribed for pain that does not respond to other medications, but tend to mask the pain rather than address its underlying cause
• glucosamine and chondroitin sulfate pills slow the progression of osteoarthritis and tend to work best when taken before the disease progresses significantly

About Cox-2 Inhibitors

Recently the Cox-2 Inhibitors – Vioxx, Celebrex and Bextra – have come under close scrutiny.  Research indicates an increased risk of heart attack, stroke and other cardiovascular events after 18 months of use.  The research findings are being taken seriously by health officials and acted on accordingly.  The FDA took Vioxx and Bextra off the market, and now requires strong warnings on Celebrex labels. 

However, in the midst of these recent actions, medical experts are keeping in mind that the Cox-2 Inhibitors have been successful in treating severe joint problems.  Officials at the Arthritis Foundation, for example, believe the ensuing discussion "has failed to take into account the potential benefits from these drugs and their contribution to improving the lives of millions of people with arthritis."  The Foundation also acknowledges that there are other NSAIDs that make suitable substitutes for those taking Cox-2 Inhibitors. Research indicates the cardiovascular side effects are related to dosage size.  As a result, some doctors are prescribing the smallest dose of Celebrex that's still effective for the patient.  We're likely to see more research conducted, and additional findings appear in the news.  In the meantime, experts say the best course of action is to speak with your doctor and conduct some research of your own before coming to a decision.  Information is available from a variety of agencies and organizations.

Intra-articular treatments

Sometimes the answer is to replenish the fluids found in the troubled joint.  Doctors inject anti-inflammatory drugs that imitate the natural body fluids normally found in a joint.  These drugs lubricate arthritic joints to reduce pain, swelling, and inflammation.  They tend to work best in less advanced cases.  There are two types:

• corticosteroid (cortisone) injections imitate the fluid produced in the adrenal gland
• hyaluronic acid imitates a different bodily fluid and must be injected once a week for a total of 3 to 5 injections.  The success rate is approximately 30 percent.

Alternative therapies

For people who cannot or will not engage in traditional therapies, certain alternative approaches have shown some promise while others have not.

• acupuncture, which involves the insertion of needles into specific exterior body locations, has been shown to reduce pain and improve function for people with arthritis
• magnetic pulse therapy subjects the joint to a low-frequency pulsed electromagnetic field (PEMF), but research to date hasn't identified any benefits
• topical (cream) NSAIDs and vitamins are two other treatments being studied, but the data so far is inconclusive

Surgical procedures

If it becomes necessary to operate on a problem joint, there are several options.

• arthroscopy uses a small fiberoptic telescope, called an arthroscope, inserted into a joint to view and irrigate structures in the joint, trim cartilage and remove bone chips
• osteotomy involves cutting or modifying the bone to improve alignment, weight bearing or other performance characteristics, with no reliance on artificial parts or implants
• arthroplasty, the total or partial replacement of a joint with artificial components, can be very disruptive to a person's life for several months, but results generally are very positive