Intra-articular corticosteroid administration is extremely helpful for local flares for relief of pain and inflammatory swelling. Too-frequent use should be avoided owing to concerns regarding joint overuse and aggravation of joint breakdown; repeated use more than four times a year is generally to be avoided. Intra-articular hyaluronan injections, approved for injection into the knee, may improve pain and function; these agents are slower than intra-articular corticosteroids with respect to clinical response but may provide a more prolonged duration of effect.

Glucosamine and chondroitin sulfate, available without prescription, have been described as being clinically beneficial, particularly on the basis of studies in osteoarthritis of the knee. Several agents such as diacerein and doxycycline, as well as glucosamine, chondroitin sulfate, avocado-soybean unsaponifiables, and intra-articular hyaluronans, have been described as being disease modifying; additional studies are required before such agents can be definitively identified as having an effect on the disease process. Structuremodifying drugs remain a “holy grail” of osteoarthritis therapy.

Additional Therapeutic Approaches. Acupuncture has been described as being of symptomatic benefit in peripheral joint osteoarthritis, but systematic reviews suggest that although sham-controlled trials show statistically significant benefits, the efficacy is variable.

Surgery. If the patient is otherwise healthy, joint replacement can markedly improve pain and function in peripheral joints. Such joint replacement of the hip and knee is now a common procedure with a high success rate, allowing thousands of persons to regain joint movement with limited or no pain. Partial joint replacement (unicompartmental repair) is effective in a number of individuals with knee osteoarthritis, limiting time for rehabilitation with decreased operative risk. Repair of chondral defects using autologous chondrocyte transplantation or mesenchymal stem cells is undergoing significant evaluation but remains investigational.

Surgery for degenerative spine disease may also be considered to relieve severe pain, eliminate pressure and irritation of spinal nerve roots and the spinal cord, and stabilize the spine, allowing rehabilitation of severely affected patients.