Remember: the goal is improved physical and emotional function more than merely pain control!!!
Glucosamine sulfate 1500-2000mg with Chondroitin sulfate 1200mg/day taken once daily are the only proven joint cartilage protective medicines known and are highly recommended, whether it provides symptomatic relief or not!
Tumeric (standardized curcumin extract), with or without Boswellia (frankincense), has proof that it is as or more effective than ibuprofen and naproxen, without the cardiac, gastrointestinal or kidney risks! Dose is 750mg of each per day, in divided doses taken twice daily. Great way to wean off Advil/Aleve/prescription anti-inflammatory medications.
High dose concentrated fish oil (to get at least 2000mg/day of EPA) is great for circulatory and joint health as a way to lower systemic inflammation and counteract (somewhat) an inflammatory diet (S.A.D. or standard American diet!).
Other research proven supplements include SAM-E 400-600mg twice daily without food and rose hips. SAM-E cannot be taken with most anti-depressants.
MSM 1500-3000mg / day can be synergistic with glucosamine and should be used if it provides some symptomatic relief. It is an essential nutrient for healing all injured connective tissues.
Niacinamide 1000mg twice daily has great biochemistry research that it protects joints and it therefore makes sense to try, even if definitive proof is lacking.
Although not really well proven it can be worth trying either an herbal anti-inflammatory combination product like Zyflamend or food enzyme product like Wobenzyme taken 3x/day between meals.
Regular medication would typically be sustained release acetaminophen (Tylenol) and NSAIDS (ibuprofen, naproxen, diclofenac, Celebrex, etc.). I strongly recommend against NSAIDS as they have very significant risks, and actually cause progression of arthritis! If needed, pure pain medications such as tramadol or hydrocodone can improve function and lessen pain.
The homeopathic creams Traumeel, Zeel or Triflora can be worth trying, especially for hands and feet. Prescription topical alternatives include the anti-inflammatory Voltarin (diclofenac) gel or Flector (diclofenac) patches. Topical capsaicin cream 0.025% (Zostrix, etc) applied 4x/day has been proven to improve pain (but it does burn initially!) and is best on hands and feet.
Injections of hyaluronic acid gel (Hyalgan, Synvisc, Supartz, Euflexxa, etc) weekly for 3-5 weeks. Generally only insurance covered for the knee. Results are variable, take an average of 5 weeks after treatment to see an effect, but when effective it can provide up to 6 months of relief.
Regenerative / prolotherapy injection into the joint and supporting ligaments with proliferants (mostly a simple dextrose solution) to stimulate the body to release growth factors and heal, done using ultrasound or x-ray guidance. Typical treatment course would be monthly for 3-6 months. These would not be covered by most insurance companies. Can be quite effective when there is no excess fluid in the joint, and can tighten up loose ligaments that often cause instability and pain.
Regenexx® SCP Super Concentrated Platelets (autologous highly concentrated and purified acellular platelet rich plasma) injections every 3-8 weeks 2-5 times, done using ultrasound or x-ray guidance. Generally not covered by insurance carriers at this time.
Regenexx SD+ stem cell injections, taken from a patient’s posterior pelvis / iliac crests as a bone marrow aspirate that is then super concentrated in our on-site laboratory into various types of stem cells that are then injection into the arthritic joint, done using ultrasound or x-ray guidance. Also a non-covered service.
Arthroscopic debridement (house cleaning) is rarely done and in and of itself is often not very effective unless there is blocked motion from degenerative changes. When this is done it is best to follow up with SD+ and/or SCP once the swelling goes down.
Joint replacement surgery would be the last option, and “success rate” is 90% but satisfaction with the results is in the 50-60% range (higher for Regenexx SD+!).