Osteoarthritis (OA) is the most prevalent form of arthritis, affecting millions of adults globally. This degenerative joint condition involves the breakdown of cartilage that cushions the ends of bones, leading to pain, stiffness, and loss of mobility in joints like the knees, hips, and hands. Because OA is a progressive, long-term condition, effective management requires a collaborative approach focused on controlling pain, improving function, and slowing disease progression.
Initial Consultation and Ongoing Care
The journey for most people with suspected joint pain begins with their Primary Care Provider (PCP), such as a family medicine doctor or internist. The PCP handles the initial assessment, including a review of symptoms, a physical examination, and basic diagnostic imaging. X-rays are commonly used to look for characteristic signs of OA, such as joint space narrowing or bone spurs. Initial management involves conservative strategies, including lifestyle modifications like weight reduction and regular, low-impact exercise, which lowers stress on weight-bearing joints. If symptoms worsen or the diagnosis remains uncertain, the PCP initiates referrals to specialized medical or surgical doctors.
Doctors Specializing in Medical Treatment
If initial treatment fails, patients are referred to doctors specializing in the non-surgical medical management of joint conditions. Rheumatologists are internal medicine physicians trained in diagnosing and treating diseases affecting the joints, muscles, and bones. Their expertise is useful for confirming the OA diagnosis and differentiating it from inflammatory forms of arthritis, such as rheumatoid arthritis, which require different treatments.
Rheumatologists manage complex OA cases using advanced medical treatments. This includes specialized joint injections, such as corticosteroid injections to reduce inflammation, or viscosupplementation, which involves injecting gel-like substances to improve lubrication and shock absorption.
Another specialist is the Physiatrist, a physician specializing in Physical Medicine and Rehabilitation (PM&R). Physiatrists focus on restoring function and improving quality of life without relying on surgery. They design personalized treatment plans that combine medications, interventional procedures like nerve blocks, and therapeutic exercises. They work closely with physical and occupational therapists to maximize the patient’s mobility and independence.
Orthopedic Surgeons and Joint Replacement
Orthopedic Surgeons specialize in the surgical treatment of the musculoskeletal system. Their involvement typically occurs when OA has progressed to a severe or end-stage level, characterized by persistent, debilitating pain and significant loss of function that has not responded to conservative medical treatments. Surgeons perform several procedures for advanced OA, ranging from joint preservation to joint replacement.
One option is an osteotomy, which involves cutting and reshaping the bone near the damaged joint to realign the limb and shift weight away from the worn cartilage. For the most severe cases, the surgeon performs an arthroplasty, or surgical replacement of the joint. Total joint replacements, particularly for the hip and knee, are the most common procedures used to reduce pain and restore mobility when the joint is fully destroyed. Orthopedic doctors also provide non-surgical care, such as corticosteroid or lubricating injections, before recommending an operation.
The Role of Physical and Rehabilitative Therapy
Physical Therapists (PTs) and Occupational Therapists (OTs) are integral members of the care team, focusing on functional outcomes. Physical therapists concentrate on improving physical function through specific exercise protocols designed to enhance muscle strength, increase joint range of motion, and improve balance and gait. They teach targeted exercises for home use and may employ modalities like heat, cold, or electrical stimulation to manage pain and stiffness.
Occupational Therapists (OTs) focus on the mechanics of daily living, helping patients adapt to limitations caused by joint pain. They analyze how a person performs routine tasks, such as dressing or cooking, and suggest modifications to minimize strain on affected joints. OTs may recommend specialized adaptive equipment, such as tools with larger grips or assistive devices like canes and walkers, to conserve joint energy and maintain independence.
For patients whose primary concern is chronic, unremitting pain, a dedicated Pain Management doctor may be consulted. These specialists, often anesthesiologists or neurologists, focus on interventional techniques and specialized medications to target pain pathways not adequately addressed by other treatments.