This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Conservative treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Conservative treatment of osteoarthritis includes:

  • aids, such as a walking stick
  • exercise - improvement of the nutrition to the cartilage, physiotherapy to strengthen the capsule and the muscles
    • exercise and weight loss are considered core treatments for patients with osteoarthritis (1)

NICE state (1):

  • Non-pharmacological management
    • exercise
      • for all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness)
      • consider supervised therapeutic exercise sessions
      • advise people it may initially cause pain or discomfort but long term adherence to an exercise plan will benefit the joints, reduce pain and improve function
      • consider combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package
    • manual therapy
      • only consider for hip and knee osteoarthritis and alongside therapeutic exercise
    • weight management
      • for people who are living with overweight or obesity:
        • advise them that weight loss will improve quality of life and physical function, and reduce pain
        • support them to choose a weight loss goal
        • explain that any weight loss is likely to be beneficial, but losing 10% is likely to be better than 5%
    • consider walking aids for lower limb osteoarthritis
    • NICE state various non-pharmacological interventions should not be offered:
      • acupuncture or dry needling
      • electrotherapy treatments
      • insoles, braces, tape, splints or supports routinely

  • Pharmacological management
    • topical, oral and transdermal medicines
      • if pharmacological treatments are needed to manage osteoarthritis, use them:
        • alongside non-pharmacological treatments and to support therapeutic exercise
        • at the lowest effective dose for the shortest possible time
      • a topical non-steroidal anti-inflammatory drug (NSAID) should be offered to people with knee osteoarthritis
      • consider a topical NSAID for people with osteoarthritis that affects other joints
      • if topical medicines are ineffective or unsuitable, consider an oral NSAID for people with osteoarthritis and take account of:
        • potential gastrointestinal, renal, liver and cardiovascular toxicity
        • any risk factors the person may have, including age, pregnancy, current medication and comorbidities
          • offer a gastroprotective treatment (such as a proton pump inhibitor) for people with osteoarthritis while they are taking an NSAID
    • NICE state these interventions should not be offered:
      • paracetamol or weak opioids routinely, unless:
        • used infrequently for short term pain relief
        • all other treatments are ineffective or unsuitable
      • glucosamine
      • strong opioids
      • intraarticular hyaluronan injections
    • intraarticular corticosteroid injections should be considered for short term relief when other pharmacological treatments are ineffective or unsuitable or to support therapeutic exercise
      • intra-articular corticosteroids injections are a widely used treatment for pain from symptomatic osteoarthritis (2)
        • systematic reviews show that the treatment effect is modest compared with intra-articular saline (often considered as placebo) and lasts for 2–4 weeks on average

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.


Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.