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Osteoarthritis is a painful and long-term condition affecting 1.4 million people in Australia. It is caused by a deterioration of the cartilage in the joints.

While osteoarthritis cannot be cured, much can be done to minimise the pain and disability associated with it. Managing arthritis typically involves getting advice from your doctor, physiotherapist and other health professionals, treatments to minimise your pain and stiffness, and regular physical activity.

Work with your health professionals

Osteoarthritis is a chronic condition, so you are more likely to manage it successfully if you work with your doctor, physiotherapist and other health professionals, use a variety of strategies, and think long term. In particular, it is important that you and your health professionals work out how to manage any pain early by developing a pain management plan. It may take some experimenting to find the combination of medicines and other treatments that works best for you, but the effort may save you much pain and disability.

Medicines for arthritis

The medicines your doctor recommends will depend on the severity of your symptoms, the other medicines you are taking, and your other health conditions.

Paracetamol
Paracetamol is the most appropriate painkiller for many people with osteoarthritis. It relieves mild-moderate pain and has few side effects. Some of the more common brands of paracetamol are listed in the box below. Like any other medicine, paracetamol must be taken at the right dose and time. Some people find that paracetamol does not seem to work. However, research has shown that these people are often not taking large enough doses or are not taking it often enough. Talk to your doctor about the right dose for you.

If your pain is persistent, try taking the recommended dose of paracetamol regularly. Taking paracetamol regularly means taking it according to the clock, ie every 4-6 hours, not according to your pain levels. Slow-release paracetamol tablets are now available on prescription for people with osteoarthritis. The slow-release tablets only need to be taken three times a day, which is usually easier to fit into a daily routine than four times a day.

Many people for whom paracetamol does not 'work' are
not taking enough.

If your pain is provoked by certain activities, such as going for a walk, try taking the recommended dose of paracetamol half an hour before starting the activity and again four hours later.

Taking paracetamol long term is safe provided that you do not exceed the maximum dose.

If you are taking paracetamol regularly, it is important that you check the label of any over-the-counter medicines you intend taking, as many contain paracetamol. This will ensure you don't accidentally take too much paracetamol. (See Common medicines and their brand names.)

Anti-inflammatory medicines
Another group of medicines used for osteoarthritis pain are the non-steroidal anti-inflammatory (NSAID) medicines. They reduce inflammation (combination of pain and swelling), and are of two types: conventional NSAIDs and COX-2 NSAIDs. The names of some of the more common NSAIDs are shown in the box below.

NSAIDs are more likely than para-cetamol to cause side effects, especially in older people, and these side effects can be serious. Common side effects include nausea, heartburn and indigestion. The more serious side effects include stomach bleeding and an increased risk of heart conditions, especially in people already at increased risk of stomach or heart problems.

Because they can cause serious side effects, NSAIDs should be used only if

• safer treatments like paracetamol and physiotherapy have not worked
• you are not at particular risk of their side effects because of other medicines or medical conditions
• the medicine results in a definite improvement in symptoms
• your GP checks your blood pressure and reviews your medicines regularly.

Anti-inflammatories may be taken continuously, or only when you have a flare-up of symptoms, depending on your doctor's advice. Taking NSAIDs at lower doses and intermittently, rather than every day, lowers your chances of developing the more serious side effects. In general, use the lowest dose that controls your pain, and use only when needed. Before taking any NSAID, including over-the-counter products like ibuprofen, ask your doctor about your risk of developing side effects. If taking paracetamol regularly does not control your pain, NSAIDs may be used in combination with paracetamol. This approach allows you to use a lower dose of the NSAID, or to take it less often.

Glucosamine
If taken for several months, there is some evidence that glucosamine sulphate can be moderately effective in relieving the symptoms of osteoarthritis, with few side effects. However, if you have diabetes, check with your doctor before taking glucosamine.

Some common medicines for osteoarthritis pain
Some of these medicines are available over the counter from pharmacies and supermarkets, and others are available on prescription.

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Exercise and weight loss

Exercise is essential for decreasing pain and disability, maintaining joint flexibility and increasing muscle strength. Choose a combination of activities that suits you and is enjoyable. Include activities or exercises that strengthen and stretch your muscles, and increase your heart rate. Possible activities include walking, hydrotherapy, tai chi and yoga. Ask your doctor or physiotherapist for advice about suitable activities for you.

Being overweight increases the stress on arthritic joints, and hence increases pain and decreases mobility. Losing excess weight is one of the most important things you can do to manage your osteoarthritis.

More information and support

Arthritis Australia has several useful fact sheets, including '10 steps for living well with arthritis', 'Medicines for arthritis' and 'Managing pain'. They also provide support and arthritis self-management courses. To obtain the fact sheets or more information their services, ring or visit the Arthritis Foundation in your state or territory at 1800 011 041 or www.arthritisaustralia.com.au.