What to try for arthritis soreness

What to change during an ordinary day

Pause during chores before soreness forces you to stop. Use both hands for a heavy pan, sit when standing isn't needed, and try a higher chair. These changes save strength for walking, dressing, cooking, or time outside.

A cane, knee brace, or firm shoe can shift some joint load. Poor fit may cause a new sore area, so a therapist can match the aid to how you walk. Bring the cane or brace to later visits so its fit can be checked.

What to discuss before adding treatment

Medicine may help, but your other health needs still matter. Some pills can trouble the stomach, kidneys, or heart. A cream may help a joint close to the skin, and your doctor can check it against your medicines.

When home care isn't enough, QC Kinetix discusses orthobiologics, non-surgical procedures using material from your own body. Its medical providers, the clinicians who examine you, may discuss PRP for joint soreness. PRP is a portion of your blood prepared with extra platelets, the tiny blood parts involved in repair. Concentrated PRP contains still more platelets in that prepared portion.

When to talk about surgery alternatives

Joint replacement may help when damage and daily limits are severe. It also brings an operation, recovery time, and risks. Regenerative treatments use material from your body without surgery, but they don't fit every joint or person.

Some people discuss them as knee or hip surgery alternatives. You may also hear joint preservation, which means trying to keep your own joint rather than replace it. Ask how each treatment may change your walking, sleep, and the tasks you miss.

Sources

1. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

2. OARSI designates arthritis education plus structured land-based exercise (with dietary weight management for the knee) as CORE treatments for knee, hip and polyarticular OA. Topical NSAIDs are Level 1A for knee OA. Intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise are Level 1B/2 for the KNEE only and are NOT recommended for hip or polyarticular OA. Acetaminophen is conditionally not recommended, and no oral NSAID is recommended for people with cardiovascular comorbidity or frailty.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

3. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 studies, with high-quality evidence from 44 trials (3,537 participants) that exercise reduces pain immediately after treatment, and further high-quality evidence that it improves physical function. Benefit attenuates but persists for at least two to six months after the programme ends.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD004376.pub3.

4. In a randomized trial of 156 US Military Health System primary-care patients with knee osteoarthritis, physical therapy beat glucocorticoid injection at one year: mean WOMAC total scores were 37.0 with physical therapy versus 55.8 with injection (mean between-group difference 18.8 points, 95% CI 5.0 to 32.6, lower is better), with secondary outcomes in the same direction.

   Deyle GD, et al. — Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.. N Engl J Med, 2020. DOI: 10.1056/NEJMoa1905877.

5. In a two-year double-blind randomized trial of 140 patients with symptomatic knee OA and ultrasonic synovitis, intra-articular triamcinolone 40 mg every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

6. A BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found that in the pre-specified main analysis of 24 large placebo-controlled trials (8,997 participants), viscosupplementation reduced pain by only SMD -0.08 (95% CI -0.15 to -0.02) - about 2.0 mm on a 100 mm scale - with the confidence interval excluding the minimal clinically important difference of -0.37. Trial sequential analysis indicated conclusive evidence of clinical equivalence to placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

7. The RESTORE randomized clinical trial (n=288) compared three weekly intra-articular injections of leukocyte-poor PRP with saline placebo in symptomatic mild-to-moderate medial knee OA. At 12 months the mean change in knee pain was -2.1 versus -1.8 points (difference -0.4, 95% CI -0.9 to 0.2, P=.17) and the mean change in medial tibial cartilage volume was -1.4% versus -1.2% (P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

8. A systematic review and meta-analysis of 25 randomized trials (1,048 participants) found mesenchymal stromal cell therapy for knee OA lowered 12-month pain VAS by 1.91 points versus viscosupplementation and by only 0.99 points versus placebo - and rated the certainty of evidence VERY UNCERTAIN by GRADE for both comparisons. Excluding high-risk-of-bias studies left a similar effect at moderate certainty versus viscosupplementation.

   Tabet CG, et al. — Advanced therapy with mesenchymal stromal cells for knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials.. J Orthop Translat, 2024. DOI: 10.1016/j.jot.2024.07.012.

9. A triple-blind randomized within-patient trial injected placental mesenchymal stromal cell-derived extracellular vesicles into one knee and saline into the other in 29 patients with bilateral grade 2-3 knee OA. NO statistically significant difference was detected between the treated and control knees on VAS, WOMAC or Lequesne scores at 2 or 6 months.

   Bolandnazar NS, et al. — Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial.. BMC Musculoskelet Disord, 2024. DOI: 10.1186/s12891-024-07979-w.

10. In the only randomized trial of total knee replacement (100 patients with moderate-to-severe knee OA), the surgery group improved more on the KOOS4 score at 12 months than the non-surgical group (32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) - but had four times the serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group chose surgery within the year while 74% did not.

    Skou ST, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. N Engl J Med, 2015. DOI: 10.1056/NEJMoa1505467.

11. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

    U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.