What to try for joint soreness

What to try at home first

Use gentle movement so stiffness doesn't build. Light strength work can reduce strain during daily tasks. Begin slowly and check the soreness tomorrow before doing more. Don't push through a sharp increase.

A cane or brace can steady some joints. Creams and gels rubbed on the skin are topical medicines. They can help a knee or hand during ordinary tasks. Your doctor can tell you whether they'll mix safely with your medicines.

What to ask about non-surgical care

If home care isn't enough, take your notes to a visit. Say what helped and which task remains hard. Ask how soon any benefit could appear. You'll also want the risks, cost, and number of visits.

QC Kinetix offers consultations for ongoing joint soreness. Its medical providers examine you and discuss non-surgical regenerative treatments made from your prepared blood. They're also called biologic therapies. The aim is easier daily movement and a better quality of life, without starting with surgery.

When to discuss a different next step

Some pills for soreness can harm the stomach, kidneys, or heart. Review them with a doctor who knows your health. Creams and gels have different risks. More medicine doesn't always bring more relief.

Surgery may come up when walking, sleep, or basic tasks keep getting harder. Ask which operation is being considered and why. Recovery takes work and carries risk. Compare that with the likely result of continuing non-surgical care.

Sources

1. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

2. OARSI designates arthritis education plus structured land-based exercise (with dietary weight management for the knee) as CORE treatments for knee, hip and polyarticular OA. Topical NSAIDs are Level 1A for knee OA. Intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise are Level 1B/2 for the KNEE only and are NOT recommended for hip or polyarticular OA. Acetaminophen is conditionally not recommended, and no oral NSAID is recommended for people with cardiovascular comorbidity or frailty.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

3. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 studies, with high-quality evidence from 44 trials (3,537 participants) that exercise reduces pain immediately after treatment, and further high-quality evidence that it improves physical function. Benefit attenuates but persists for at least two to six months after the programme ends.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD004376.pub3.

4. The Cochrane review of exercise for HIP osteoarthritis found high-quality evidence from nine trials (549 participants) that exercise reduced pain (SMD -0.38, 95% CI -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment, equivalent to about 8 points of pain relief on a 0-100 scale with a number-needed-to-treat of 6.

   Fransen M, et al. — Exercise for osteoarthritis of the hip.. Cochrane Database Syst Rev, 2014. DOI: 10.1002/14651858.CD007912.pub2.

5. In the 454-person IDEA randomized trial, 18 months of intensive diet plus exercise produced 10.6 kg (11.4%) mean weight loss and less pain and better function than either diet alone or exercise alone in overweight and obese adults aged 55 and older with painful radiographic knee OA. The exercise-only group lost 1.8 kg (2.0%).

   Messier SP, et al. — Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial.. JAMA, 2013. DOI: 10.1001/jama.2013.277669.

6. The Cochrane review of topical NSAIDs for chronic musculoskeletal pain pooled 39 studies with 10,631 participants, all of which examined topical NSAIDs for the treatment of osteoarthritis, using 'clinical success' (at least 50% pain reduction or equivalent) as the primary outcome.

   Derry S, et al. — Topical NSAIDs for chronic musculoskeletal pain in adults.. Cochrane Database Syst Rev, 2016. DOI: 10.1002/14651858.CD007400.pub3.

7. In a two-year double-blind randomized trial of 140 patients with symptomatic knee OA and ultrasonic synovitis, intra-articular triamcinolone 40 mg every 12 weeks produced significantly greater cartilage volume loss than saline (index compartment cartilage thickness change -0.21 mm vs -0.10 mm; between-group difference -0.11 mm, 95% CI -0.20 to -0.03) with NO significant difference in pain.

   McAlindon TE, et al. — Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial.. JAMA, 2017. DOI: 10.1001/jama.2017.5283.

8. A BMJ systematic review and meta-analysis of 169 trials (21,163 participants) found that in the pre-specified main analysis of 24 large placebo-controlled trials (8,997 participants), viscosupplementation reduced pain by only SMD -0.08 (95% CI -0.15 to -0.02) - about 2.0 mm on a 100 mm scale - with the confidence interval excluding the minimal clinically important difference of -0.37. Trial sequential analysis indicated conclusive evidence of clinical equivalence to placebo since 2009.

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

9. The RESTORE randomized clinical trial (n=288) compared three weekly intra-articular injections of leukocyte-poor PRP with saline placebo in symptomatic mild-to-moderate medial knee OA. At 12 months the mean change in knee pain was -2.1 versus -1.8 points (difference -0.4, 95% CI -0.9 to 0.2, P=.17) and the mean change in medial tibial cartilage volume was -1.4% versus -1.2% (P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no significant between-group difference.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

10. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

    U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

11. In the only randomized trial of total knee replacement (100 patients with moderate-to-severe knee OA), the surgery group improved more on the KOOS4 score at 12 months than the non-surgical group (32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) - but had four times the serious adverse events (24 vs 6, P=0.005), and 26% of the non-surgical group chose surgery within the year while 74% did not.

    Skou ST, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. N Engl J Med, 2015. DOI: 10.1056/NEJMoa1505467.