Several treatments can meaningfully reduce osteoarthritis pain and slow its progression, ranging from weight loss and exercise to anti-inflammatory medications, injections, and joint braces. The most effective approach combines multiple strategies, starting with lifestyle changes and layering in other options as needed.
Why Osteoarthritis Gets Worse Over Time
Understanding what’s happening inside the joint helps explain why certain treatments work. In a healthy joint, cartilage acts as a smooth cushion between bones. In osteoarthritis, the cells that maintain cartilage (chondrocytes) try to repair damage but accidentally trigger enzymes and inflammatory signals that break the cartilage down faster. This creates a cycle: damage triggers repair attempts, repair attempts trigger more inflammation, and inflammation destroys more cartilage.
As cartilage wears away, the bone underneath stiffens and develops cysts and bony spurs called osteophytes at the joint margins. The joint lining becomes mildly inflamed and produces extra fluid that’s thinner and less lubricating than normal. Eventually, exposed bone becomes hardened and polished from rubbing against the opposite surface. Every effective treatment targets some part of this cycle, whether by reducing inflammation, taking pressure off the joint, or both.
Weight Loss Has an Outsized Effect
Excess weight accelerates osteoarthritis through two pathways. The obvious one is mechanical: more body weight means more force on weight-bearing joints. The less obvious one is chemical. Fat tissue releases inflammatory compounds called adipokines that directly damage cartilage and remodel the bone underneath, which is why obesity worsens osteoarthritis even in non-weight-bearing joints like the hands.
A 2025 meta-analysis of weight loss trials in people with knee osteoarthritis found that significant pain relief kicked in at around 7.4% body weight reduction. For someone weighing 200 pounds, that’s roughly 15 pounds. The analysis found that combining a structured diet with exercise produced the best results for both pain and physical function. Losing weight won’t rebuild lost cartilage, but it can meaningfully change how your joints feel day to day.
Exercise That Protects Your Joints
It sounds counterintuitive to exercise a painful joint, but movement is one of the most consistently supported treatments for osteoarthritis. The current recommendation from major rheumatology organizations is the same as for the general population: at least 150 minutes of moderate-intensity aerobic activity per week (or 75 minutes of vigorous activity), plus regular strength, flexibility, and balance exercises.
Aerobic exercise like walking, cycling, or swimming reduces pain and improves cardiovascular health. Strength training builds the muscles that stabilize and support joints, reducing the load on damaged cartilage. Flexibility work preserves range of motion, and balance or “neuromotor” exercises lower fall risk, which matters when joint instability is part of the picture. You don’t need to do all of these in one session. Spreading them across the week works just as well.
If you’re starting from very little activity, even modest increases help. The key is consistency over intensity. A physical therapist can design a program that accounts for which joints are affected and how severe the damage is.
Anti-Inflammatory Medications
For knee osteoarthritis, topical anti-inflammatory gels and creams are a first-line option. Applied directly to the skin over the joint, they deliver pain relief with minimal side effects, mostly limited to mild, temporary skin irritation. Guidelines from the Osteoarthritis Research Society International specifically recommend topical options for people with heart disease, stomach problems, or general frailty.
Oral anti-inflammatories like ibuprofen and naproxen are effective but come with tradeoffs. A large network meta-analysis published in The BMJ found that meloxicam and diclofenac were more effective than ibuprofen and naproxen at their maximum doses, with similar safety profiles. However, all oral anti-inflammatories carry a slight increased risk of gastrointestinal and cardiovascular problems, making them a poor fit for long-term daily use or for people with existing heart or stomach conditions. If you have gastrointestinal issues, a class of anti-inflammatories called COX-2 inhibitors carries lower stomach risk, though cardiovascular concerns remain.
Acetaminophen (Tylenol) is sometimes recommended, but its pain relief for osteoarthritis is modest compared to anti-inflammatories, since it doesn’t address the joint inflammation driving much of the discomfort.
Curcumin: A Supplement With Real Evidence
Curcumin, the active compound in turmeric, has stronger clinical support than most joint supplements. A systematic review and meta-analysis found that curcumin supplements were associated with better pain relief than anti-inflammatory drugs for knee osteoarthritis, with fewer side effects. Interestingly, doses above 1,000 mg per day didn’t perform better than lower doses, so more isn’t necessarily better.
The catch is that curcumin is poorly absorbed on its own. Most effective supplements use formulations with added black pepper extract or other absorption enhancers. If you try curcumin, look for a product that specifies its bioavailability strategy on the label.
Glucosamine and Chondroitin: Mixed Results
Glucosamine and chondroitin are among the most popular joint supplements, but the evidence is frustratingly inconsistent. A combined analysis of 29 studies involving over 6,000 people with knee osteoarthritis found that glucosamine and chondroitin each reduced pain when taken separately, but not when taken together. Individual study results varied widely.
The picture is similarly muddled for slowing structural damage. A two-year Australian trial of 605 participants found that the combination of glucosamine and chondroitin reduced joint space narrowing (a sign the cartilage cushion is thinning). But a comparable U.S. trial of 572 participants found no difference between any supplement group and placebo. Two other trials found chondroitin alone helped preserve joint space, directly contradicting the Australian study where chondroitin alone did nothing.
One consistent finding: pharmaceutical-grade chondroitin performed better than lower-quality preparations. Brand and formulation seem to matter more than whether you take the supplement at all, which may explain some of the conflicting results. If you want to try glucosamine or chondroitin, a three-month trial is reasonable to see if you notice improvement.
Joint Injections
Hyaluronic acid injections deliver a gel-like lubricant directly into the joint, supplementing the thinned-out fluid that osteoarthritis produces naturally. An umbrella review covering 22 systematic reviews found that 20 out of 22 reported significant benefits for pain and function, and all five of the highest-quality reviews supported its effectiveness. These injections are typically used for knee osteoarthritis when other treatments haven’t provided enough relief, and their effects can last several months.
Corticosteroid injections are another option that can provide rapid pain relief by tamping down inflammation inside the joint. They tend to work faster than hyaluronic acid but wear off sooner, often within a few weeks to a couple of months. Repeated corticosteroid injections may accelerate cartilage loss over time, so most doctors limit their frequency.
Braces and Physical Aids
Unloading knee braces work by redistributing weight away from the damaged part of the joint. Most knee osteoarthritis affects the inner (medial) compartment. An unloading brace uses a three-point pressure system to gently force that compartment open, reducing the bone-on-bone friction that causes pain. They’re most useful for people with damage concentrated on one side of the knee rather than throughout the entire joint.
Supportive footwear and shoe inserts can also change how forces travel through the leg. A wedged insole, for example, can shift load away from the medial compartment of the knee in a similar way to a brace, though the effect is smaller. Walking aids like a cane, used in the hand opposite the affected knee, reduce joint loading by about 10 to 15 percent.
When Joint Replacement Becomes the Right Call
Joint replacement surgery is reserved for osteoarthritis that hasn’t responded adequately to other treatments. The general threshold is pain rated at least 3 out of 10 that interferes with your ability to perform daily activities like dressing, cooking, or walking. Imaging needs to show significant cartilage loss, typically graded on standardized scales from X-rays or MRI taken within the past year.
Before surgery is approved, most guidelines expect you to have tried a reasonable course of non-surgical treatments over at least six months. If you have diabetes, keeping blood sugar well-controlled (hemoglobin A1C of 8% or below) is strongly recommended before surgery to reduce complication risk. For people with a BMI of 40 or above, weight reduction before surgery is also strongly encouraged. Modern joint replacements for knees and hips have high success rates, with most people experiencing significant pain relief and improved mobility that lasts 15 to 20 years or longer.