The benefit of nonpharmacologic therapy to treat symptomatic osteoarthritis

  • Yvonne C. LeeEmail author
  • Robert H. Shmerling


Osteoarthritis affects a large proportion of the population, especially the elderly, leading to pain and disability. To relieve pain, many patients are turning toward nonpharmacologic therapies. Conventional nonpharmacologic treatments such as weight loss and exercise are well accepted by the medical community, and some randomized controlled trials support the use of these treatments in patients with knee osteoarthritis. However, little information exists regarding the efficacy of these treatments for osteoarthritis at other sites. Less conventional treatments such as acupuncture and massage are emerging as promising options for osteoarthritis treatment, but the magnitude of benefit has varied between studies. More investigation is necessary to reach a conclusion regarding the efficacy of these treatments.


Knee Osteoarthritis Massage Therapy Sham Acupuncture Nonpharmacologic Therapy WOMAC Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

  1. 1.
    Lawrence RC, Helmick CG, Arnett FC, et al.: Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998, 41:778–799.PubMedCrossRefGoogle Scholar
  2. 2.
    Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000, 43:1905–1915.Google Scholar
  3. 3.
    Barnes P, Powell-Grimer E, McFann K, et al.: Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004, (343):1–19.Google Scholar
  4. 4.
    Katz P, Lee F: Racial/ethnic differences in the use of complementary and alternative medicine in patients with arthritis. J Clin Rheumatol 2007, 13:3–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Christensen R, Bartels EM, Astrup A, et al.: Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007, 66:433–439.PubMedCrossRefGoogle Scholar
  6. 6.
    Messier SP, Loeser RF, Miller GD, et al.: Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum 2004, 50:1501–1510.PubMedCrossRefGoogle Scholar
  7. 7.
    Focht BC, Rejeski WJ, Ambrosius WT, et al.: Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum 2005, 53:659–665.PubMedCrossRefGoogle Scholar
  8. 8.
    Devos-Comby L, Cronan T, Roesch SC: Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. J Rheumatol 2006, 33:744–756.PubMedGoogle Scholar
  9. 9.
    Roddy E, Zhang W, Doherty M: Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis 2005, 64:544–548.PubMedCrossRefGoogle Scholar
  10. 10.
    Mikesky AE, Mazzuca SA, Brandt KD, et al.: Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum 2006, 55:690–699.PubMedCrossRefGoogle Scholar
  11. 11.
    Fransen M, McConnell S, Bell M: Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2003, (3):CD004286.Google Scholar
  12. 12.
    Tak E, Staats P, Van Hespen A, et al.: The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol 2005, 32:1106–1113.PubMedGoogle Scholar
  13. 13.
    Brismee JM, Paige RL, Chyu MC, et al.: Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil 2007, 21:99–111.PubMedCrossRefGoogle Scholar
  14. 14.
    Fransen M, Nairn L, Winstanley J, et al.: Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum 2007, 57:407–414.PubMedCrossRefGoogle Scholar
  15. 15.
    Hinman RS, Heywood SE, Day AR: Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther 2007, 87:32–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Kolasinski SL, Garfinkel M, Tsai AG, et al.: Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med 2005, 11:689–693.PubMedCrossRefGoogle Scholar
  17. 17.
    Buszewicz M, Rait G, Griffin M, et al.: Self management of arthritis in primary care: randomised controlled trial. BMJ 2006, 333:879.PubMedCrossRefGoogle Scholar
  18. 18.
    Veenhof C, Koke AJ, Dekker J, et al.: Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: a randomized clinical trial. Arthritis Rheum 2006, 55:925–934.PubMedCrossRefGoogle Scholar
  19. 19.
    Coupe VM, Veenhof C, van Tulder MW, et al.: The cost effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee. Ann Rheum Dis 2007, 66:215–221.PubMedCrossRefGoogle Scholar
  20. 20.
    Beyerman KL, Palmerino MB, Zohn LE, et al.: Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. J Manipulative Physiol Ther 2006, 29:107–114.PubMedCrossRefGoogle Scholar
  21. 21.
    Kirkley A, Webster-Bogaert S, Litchfield R, et al.: The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am 1999, 81:539–548.PubMedGoogle Scholar
  22. 22.
    Brouwer RW, van Raaij TM, Verhaar JA, et al.: Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage 2006, 14:777–783.PubMedCrossRefGoogle Scholar
  23. 23.
    Draganich L, Reider B, Rimington T, et al.: The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis. J Bone Joint Surg Am 2006, 88:2645–2652.PubMedCrossRefGoogle Scholar
  24. 24.
    Brouwer RW, Jakma TS, Verhagen AP, et al.: Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2005, (1):CD004020.Google Scholar
  25. 25.
    Baker K, Goggins J, Xie H, et al.: A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum 2007, 56:1198–1203.PubMedCrossRefGoogle Scholar
  26. 26.
    Toda Y, Tsukimura N: A 2-year follow-up of a study to compare the efficacy of lateral wedged insoles with subtalar strapping and in-shoe lateral wedged insoles in patients with varus deformity osteoarthritis of the knee. Osteoarthritis Cartilage 2006, 14:231–237.PubMedCrossRefGoogle Scholar
  27. 27.
    Jan MH, Chai HM, Wang CL, et al.: Effects of repetitive shortwave diathermy for reducing synovitis in patients with knee osteoarthritis: an ultrasonographic study. Phys Ther 2006, 86:236–244.PubMedGoogle Scholar
  28. 28.
    Laufer Y, Zilberman R, Porat R, et al.: Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial. Clin Rehabil 2005, 19:255–263.PubMedCrossRefGoogle Scholar
  29. 29.
    Berman B: A 60-year-old woman considering acupuncture for knee pain. JAMA 2007, 297:1697–1707.PubMedCrossRefGoogle Scholar
  30. 30.
    Manheimer E, Lim B, Lao L, et al.: Acupuncture for knee osteoarthritis—a randomised trial using a novel sham. Acupunct Med 2006, 24(Suppl):S7–S14.PubMedCrossRefGoogle Scholar
  31. 31.
    Witt CM, Jena S, Brinkhaus B, et al.: Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis Rheum 2006, 54:3485–3493.PubMedCrossRefGoogle Scholar
  32. 32.
    Kwon YD, Pittler MH, Ernst E: Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2006, 45:1331–1337.CrossRefGoogle Scholar
  33. 33.
    Scharf HP, Mansmann U, Streitberger K, et al.: Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006, 145:12–20.PubMedGoogle Scholar
  34. 34.
    Witt C, Brinkhaus B, Jena S, et al.: Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005, 366:136–143.PubMedCrossRefGoogle Scholar
  35. 35.
    Berman BM, Lao L, Langenberg P, et al.: Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004, 141:901–910.PubMedGoogle Scholar
  36. 36.
    Vas J, Mendez C, Perea-Milla E, et al.: Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 2004, 329:1216.PubMedCrossRefGoogle Scholar
  37. 37.
    Manheimer E, Linde K, Lao L, et al.: Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med 2007, 146:868–877.PubMedGoogle Scholar
  38. 38.
    White A, Foster NE, Cummings M, et al.: Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford) 2007, 46:384–390.CrossRefGoogle Scholar
  39. 39.
    Williamson L, Wyatt MR, Yein K, et al.: Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford) 2007, 46:1445–1449.CrossRefGoogle Scholar
  40. 40.
    Foster NE, Thomas E, Barlas P, et al.: Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ 2007, 335:436.PubMedCrossRefGoogle Scholar
  41. 41.
    Reinhold T, Witt CM, Jena S, et al.: Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ 2007, [Epub ahead of print].Google Scholar
  42. 42.
    Perlman AI, Sabina A, Williams AL, et al.: Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med 2006, 166:2533–2538.PubMedCrossRefGoogle Scholar
  43. 43.
    Balint GP, Buchanan WW, Adam A, et al.: The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis—a double blind study. Clin Rheumatol 2007, 26:890–894.PubMedCrossRefGoogle Scholar
  44. 44.
    Yurtkuran M, Yurtkuran M, Alp A, et al.: Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int 2006, 27:19–27.PubMedCrossRefGoogle Scholar
  45. 45.
    Towheed TE: Systematic review of therapies for osteoarthritis of the hand. Osteoarthritis Cartilage 2005, 13:455–462.PubMedCrossRefGoogle Scholar
  46. 46.
    Zhang W, Doherty M, Leeb BF, et al.: EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007, 66:377–388.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Division of Rheumatology, Immunology and AllergyRobert Breck Brigham Arthritis CenterBostonUSA

Personalised recommendations