Gold Bamboo
Home
Performance & Recovery Mind & Stress Longevity Foundations Gut & Immune
Practitioners Compare Tools About
Well-Studied

Supported by multiple clinical trials and systematic reviews

Osteoarthritis (OA)

Osteoarthritis (OA) is the most common arthritis, driven by age, mechanical loading, prior injury, obesity, and genetics. It features progressive cartilage loss, subchondral bone changes, synovial activation, and periarticular muscle weakness. Patients typically report activity-related joint pain, stiffness (often <30 minutes in the morning), reduced function, and sometimes swelling or crepitus. Knees, hips, hands, and spine are most affected. Diagnosis is clinical, supported by radiographs showing joint-space narrowing, osteophytes, and sclerosis; MRI is rarely required for routine care. Western management prioritizes nonpharmacologic strategies with the strongest, most consistent benefits across guidelines: education, exercise therapy (aerobic, strengthening, neuromuscular/balance), and weight reduction for those with overweight/obesity. Topical NSAIDs are recommended as first-line pharmacologic therapy for knee and hand OA, with oral NSAIDs used when needed and appropriate. Acetaminophen has diminishing evidence of benefit. Duloxetine can help chronic OA pain, particularly knee OA. Intra-articular corticosteroid injections offer short-term relief; hyaluronic acid remains controversial with mixed evidence. Platelet-rich plasma (PRP) injections are emerging but heterogeneous and not yet guideline-endorsed broadly. Joint replacement is highly effective for end-stage disease. Eastern and traditional approaches conceptualize OA differently but often converge on movement-based and symptom-relieving therapies. In Traditional Chinese Medicine (TCM), OA commonly maps to Bi syndrome (painful obstruction) with patterns such as wind-cold-damp Bi, blood stasis, and kidney (shen) deficiency. Treatment may include acupuncture (including electroacupuncture and warm-needle techniques), moxibustion, topical herbal liniments (e.g., capsicum), tuina/manual therapy, and herbal formulas (e.g., Du Huo Ji Sheng Tang). Acupuncture for knee OA is among the best-studied TCM applications,

musculoskeletal Updated February 19, 2026

This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.

Western Medicine

Diagnosis

Clinical diagnosis is based on activity-related joint pain, brief morning stiffness, functional limitation, bony enlargement/crepitus, and exclusion of inflammatory arthritis. Radiographs support diagnosis (joint-space narrowing, osteophytes, subchondral sclerosis/cysts). ACR clinical and clinical+radiographic criteria exist for knee/hip/hand OA. MRI/ultrasound are not routinely required but may clarify alternative pathology or effusion/synovitis.

Treatments

  • Education and self-management programs
  • Exercise therapy: aerobic, quadriceps/hip strengthening, neuromuscular/balance training
  • Weight loss (≥5–10% for knee/hip OA if overweight/obese)
  • Topical NSAIDs (first-line for knee/hand OA)
  • Oral NSAIDs (use lowest effective dose; assess GI/CV/renal risk)
  • Acetaminophen (limited benefit; consider only if NSAIDs not appropriate)
  • Duloxetine for chronic OA pain (especially knee OA)
  • Topical capsaicin (particularly for knee/hand OA)
  • Bracing (e.g., tibiofemoral unloader), cane, footwear/orthoses as indicated
  • Intra-articular corticosteroid injections (short-term relief)
  • Intra-articular hyaluronic acid (debated; variable benefit)
  • Platelet-rich plasma (PRP) injections (emerging; heterogeneity of preparations)
  • Arthroplasty (TKA/THA) for end-stage OA with severe pain and functional loss

Medications

  • Topical diclofenac gel/solution
  • Oral NSAIDs: naproxen, ibuprofen, celecoxib, meloxicam (consider PPI if GI risk)
  • Acetaminophen (paracetamol)
  • Duloxetine (30–60 mg/d; monitor for nausea, somnolence, interactions)
  • Topical capsaicin 0.025–0.075%
  • Intra-articular triamcinolone or methylprednisolone
  • Intra-articular hyaluronic acid products (various brands)
  • PRP (autologous; not standardized)

Limitations

- No disease-modifying therapy reliably halts or reverses structural OA progression. - NSAIDs carry GI bleeding, renal, and cardiovascular risks; topical options mitigate but do not eliminate risk. - Acetaminophen provides minimal pain relief in OA at safe doses. - Duloxetine benefit is modest and may be limited by tolerability. - Corticosteroid injections provide short-lived relief and repeated use may accelerate cartilage loss in some patients. - Hyaluronic acid results are inconsistent across preparations; benefit often small and debated. - PRP evidence is promising but heterogeneous and lacks standardization; cost/coverage issues. - Surgery is effective but involves perioperative risks and requires rehabilitation; prosthesis longevity is finite.

Evidence: Strong Evidence

Sources

  • Kolasinski SL et al. 2019 ACR/Arthritis Foundation Guideline for OA of the Hand, Hip, and Knee. Arthritis Care Res. 2020;72(2):149-162.
  • Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular OA. Osteoarthritis Cartilage. 2019;27:1578-1589.
  • Da Costa BR et al. Effectiveness of non-steroidal anti-inflammatory drugs for OA pain: network meta-analysis. BMJ. 2017;356:j164.
  • Derry S et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016;CD007400.
  • McAlindon TE et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in OA. JAMA. 2017;317(19):1967-1975.
  • Belk JW et al. PRP vs hyaluronic acid and corticosteroid for knee OA: systematic review/meta-analysis. Arthroscopy. 2021;37(10):3096-3114.
  • Clegg DO et al. Glucosamine, chondroitin sulfate, their combination, or celecoxib for knee OA (GAIT). N Engl J Med. 2006;354:795-808.

Eastern & Traditional Medicine

Traditional Chinese Medicine (TCM)

OA is categorized under Bi syndrome (painful obstruction) due to invasion of wind-cold-damp or internal deficiencies (kidney/liver) leading to poor nourishment of bones/sinews and blood stasis. Treatment principles: dispel wind/cold/damp, move qi and blood, warm channels, tonify kidney/liver, and relieve pain.

Techniques

  • Acupuncture for knee/hip/hand OA (manual, electroacupuncture)
  • Warm-needle acupuncture and moxibustion to warm channels/dispell cold-damp
  • Herbal formulas (e.g., Du Huo Ji Sheng Tang; topical herbal/capsicum plasters)
  • Tuina/manual therapy; traditional bone-setting (die-da) in select cases
Licensed acupuncturist (LAc) TCM physician Tuina/manual therapist
Evidence: Moderate Evidence

Acupuncture (focused evidence for knee OA)

Reduces pain and improves function via neuromodulation, endogenous opioid release, and anti-inflammatory effects. Benefits vs usual care are moderate; benefits vs sham are small-to-moderate but statistically significant in high-quality analyses.

Techniques

  • Body acupuncture at local and distal points (e.g., Xiyan/Neixiyan, ST35, GB34)
  • Electroacupuncture for analgesia
  • Course-based care (e.g., 1–3 sessions/week for 6–12 weeks)
Licensed acupuncturist Physician acupuncturist (MD/DO)
Evidence: Moderate Evidence

Tai Chi

Mind-body exercise integrating slow movements, balance, and breathing. Improves pain, function, balance, and mood in knee OA; comparable to physical therapy in a head-to-head RCT.

Techniques

  • Yang-style group classes 1–2 times/week plus home practice
  • Neuromotor and balance training tailored to knee OA
Tai chi instructor with therapeutic/rehabilitation experience Physical therapist incorporating tai chi elements
Evidence: Strong Evidence

Ayurveda (herbal and lifestyle)

OA (Sandhigata Vata) reflects Vata aggravation affecting joints. Management includes herbal anti-inflammatories, oil massage (abhyanga), fomentation (swedana), yoga/asana, and dietary measures to reduce Vata and support joint function.

Techniques

  • Boswellia serrata extracts (AKBA; e.g., 5-Loxin, Aflapin)
  • Turmeric/curcumin standardized extracts
  • Topical oils and gentle yoga/asana
Ayurvedic practitioner/physician Integrative medicine clinician
Evidence: Moderate Evidence

Sources

  • Manheimer E et al. Acupuncture for peripheral joint OA. Cochrane Database Syst Rev. 2010;CD001977.
  • Vickers AJ et al. Acupuncture for chronic pain (incl. OA): individual patient data meta-analysis. J Pain. 2018;19(5):455-474.
  • Derry S et al. Topical capsaicin for chronic musculoskeletal pain. Cochrane Database Syst Rev. 2017;CD007393.
  • Vickers AJ et al. J Pain. 2018;19(5):455-474.
  • Hinman RS et al. Acupuncture for chronic knee pain: RCTs summarized in Cochrane reviews (2016–2018 updates).
  • OARSI 2019 guideline (acupuncture conditionally recommended/uncertain depending on joint).
  • Wang C et al. Tai Chi vs physical therapy for knee OA: randomized trial. Ann Intern Med. 2016;165(2):77-86.
  • Wang C et al. Tai Chi in knee OA: RCT. Arthritis Rheum. 2009;61(11):1545-1553.
  • Huang ZG et al. Tai Chi for knee OA: meta-analysis. Sci Rep. 2017;7:11317.
  • Sengupta K et al. 5-Loxin (Boswellia) for knee OA: RCT. Arthritis Res Ther. 2008;10:R85.
  • Kimmatkar N et al. Boswellia serrata in knee OA: RCT. Phytomedicine. 2003;10:3–7.
  • Kuptniratsaikul V et al. Curcuma domestica vs ibuprofen in knee OA: multicenter RCT. Clin Interv Aging. 2014;9:451-458.
  • Daily JW et al. Efficacy of turmeric/curcumin for OA: systematic review/meta-analysis. J Med Food. 2016;19(8):717-729.

Integrative Perspective

- Exercise is the cornerstone across paradigms: structured physical therapy, aerobic and strength training, tai chi, and yoga all improve pain and function; matching the program to patient preference increases adherence. - Weight reduction synergizes with exercise for knee/hip OA and is reinforced by both Western guidelines and Eastern lifestyle frameworks. - Acupuncture can be integrated with guideline-based care (exercise, topical/oral NSAIDs) to reduce pain and medication use; consider a defined trial (e.g., 6–8 weeks) and continue if clinically meaningful benefit is observed. - Topical capsaicin is a useful bridge: supported by Western evidence and rooted in traditional topical analgesic practice. - Supplements: discuss quality, dosing, and interactions. Curcumin may have mild antiplatelet effects; Boswellia may interact with anticoagulants and some CYP enzymes—coordinate with clinicians. - Glucosamine/chondroitin illustrate evidence complexity: the large GAIT trial was negative for the primary outcome, yet some pharmaceutical-grade chondroitin trials and a combination (MOVES) suggest modest benefit for some patients. Most Western guidelines recommend against routine use; if patients perceive benefit and tolerate them, shared decision-making with periodic stop–start trials to confirm effect is reasonable. - Intra-articular choices should be individualized: corticosteroids for short-term flares; hyaluronic acid and PRP remain debated—set expectations and review evolving evidence and cost/coverage. - Emphasize multimodal, stepwise care that prioritizes low-risk, high-yield strategies first, layering modalities while monitoring outcomes and safety.

Sources

  1. Kolasinski SL et al. 2019 ACR/Arthritis Foundation Guideline. Arthritis Care Res. 2020;72(2):149-162.
  2. Bannuru RR et al. OARSI 2019 Guidelines. Osteoarthritis Cartilage. 2019;27:1578-1589.
  3. Da Costa BR et al. BMJ. 2017;356:j164 (analgesic network meta-analysis incl. acetaminophen).
  4. Derry S et al. Cochrane 2016 (topical NSAIDs); Derry S et al. Cochrane 2017 (capsaicin).
  5. McAlindon TE et al. JAMA. 2017;317(19):1967-1975 (steroid injection cartilage loss).
  6. Belk JW et al. Arthroscopy. 2021;37(10):3096-3114 (PRP meta-analysis).
  7. Clegg DO et al. NEJM. 2006;354:795-808 (GAIT trial).
  8. Wang C et al. Ann Intern Med. 2016;165:77-86 (tai chi vs PT).
  9. Vickers AJ et al. J Pain. 2018;19:455-474 (acupuncture IPD meta-analysis).
  10. Kuptniratsaikul V et al. Clin Interv Aging. 2014;9:451-458 (curcumin).
  11. Sengupta K et al. Arthritis Res Ther. 2008;10:R85 (Boswellia).
  12. Huang ZG et al. Sci Rep. 2017;7:11317 (tai chi meta-analysis).
  13. Reginster JY et al. MOVES trial (glucosamine/chondroitin vs celecoxib). Ann Rheum Dis. 2014;73(8):1477-1487.

Health Disclaimer

This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.