Arthritis Treatment in Australia: What Helps

First, which type of arthritis?

“Arthritis” covers more than 100 conditions that affect the joints. Treatment depends on the type, so getting the right diagnosis comes first. The two main groups are:

• Osteoarthritis (OA): the most common type, affecting the cartilage and bone of joints such as the knees, hips, hands and spine.
• Inflammatory arthritis: conditions where the immune system attacks the joints, such as rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. Gout is another inflammatory type, caused by uric acid crystals.

See types of arthritis for how they differ.

Treating osteoarthritis

International guidelines, including those from Osteoarthritis Research Society International and the American College of Rheumatology, and the RACGP’s guideline for knee and hip osteoarthritis, agree on the core treatments:

• Exercise. Strengthening and aerobic exercise reduce pain and improve function. It’s the single most recommended treatment for knee and hip OA.
• Weight management. For people carrying extra weight, losing weight reduces load on the knees and hips. In one trial of adults with knee OA who were overweight, combining diet and exercise reduced pain more than exercise alone.
• Education and self-management, so you understand the condition and can pace activity.
• Tai chi and water-based exercise suit many people.
• Aids and supports, such as a walking stick, a brace for the knee, or a splint for the base of the thumb.
• Medicines, which can help with flares and pain but work best alongside exercise. Your GP or pharmacist can advise what’s suitable and safe for you.
• Surgery, such as joint replacement, for people with severe OA whose symptoms aren’t controlled. Keyhole “clean-out” surgery (arthroscopy) is not recommended for knee OA.

Treating inflammatory arthritis

Inflammatory arthritis is treated differently. In rheumatoid arthritis, starting treatment early with medicines that calm the immune system can prevent permanent joint damage. The aim is remission or very low disease activity. Treatment is usually led by a rheumatologist, with regular blood tests and reviews. Exercise, physiotherapy and stopping smoking also help.

Gout is treated by easing flares and, for many people, long-term treatment to lower uric acid levels and prevent further attacks.

What a GP can do

• Work out the likely type of arthritis from your symptoms
• Arrange blood tests and X-rays when they’d help
• Refer you to a physiotherapist, exercise physiologist or dietitian
• Refer you to a rheumatologist promptly if inflammatory arthritis is suspected
• Review your pain management and how it’s working

When to see a doctor

See a GP for joint pain that lasts more than a few weeks, joints that are swollen or stiff for more than 30 minutes in the morning, or pain that’s stopping you doing things. A single hot, red, swollen joint with fever needs same-day medical care.

References

1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759.
2. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589.
3. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162.
4. Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73.
5. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-2038.
6. Dalbeth N, Gosling AL, Gaffo A, et al. Gout. Lancet. 2021;397(10287):1843-1855.
7. RACGP. Guideline for the management of knee and hip osteoarthritis.
8. healthdirect. Arthritis.