Arthritis is a common condition that affects functional independence and quality of life in many people, especially older adults. It is a progressive, chronic condition in which one or more joints experience pain, stiffness, inflammation, and degeneration. Osteoarthritis, the most common type, was estimated to result in $80 billion in healthcare costs in the US in 2016 (1) and affects around 300 million people worldwide (2). Research has established several conservative (nonsurgical), first line treatment options for arthritis, including physical therapy, weight loss for overweight individuals, braces, NSAIDs, and corticosteroid injections (2). With multiple approaches to treatment, it is important to compare the effectiveness of different options and determine the optimal solution (1-4).
Research shows that exercise physical therapy and manual physical therapy are effective modalities of treating arthritis. One randomized controlled trial found that both significantly reduced patient WOMAC scores after a year, which represents an overall improvement in symptoms and function. Interestingly, combining exercise and manual therapy did not lead to additional improvements beyond one or the other alone (3).
There is also a high level of evidence supporting the benefit of intraarticular corticosteroid injections for arthritis in the short term. These injections aim to reduce inflammation and therefore reduce arthritis symptoms. A systematic review reported strong levels of evidence for the use of injections for rheumatoid arthritis and osteoarthritis, and limited evidence for injections for juvenile idiopathic arthritis (4).
The American College of Rheumatology and the Arthritis Foundation jointly published guidelines in 2019 for the management of osteoarthritis. Their review resulted in strong recommendations for intraarticular steroid injections for knee arthritis and for exercise more broadly, with the latter being more effective when part of structured physical therapy. In addition, conditional recommendations were made for injections for hand osteoarthritis, balance exercises, and yoga (2).
Though physical therapy and injections have both been identified as effective treatment options for arthritis on their own, less is known about which may be more effective overall. Furthermore, injections are typically utilized for and studied in the context of short-term relief, whereas physical therapy usually requires long-term commitment for the most benefit. A recent study sought to answer some of these remaining questions by comparing the cost-effectiveness of an initial treatment with physical therapy vs. joint injections for knee osteoarthritis. 156 adult participants were randomized to receive either 3 injections or 8-12 physical therapy sessions over one year. Mean related medical costs at one year were similar, though the standard deviation was much higher in the injection group. However, the physical therapy group had significantly better quality-adjusted life-years, which is a measure of quality of life (1).
Recent research suggests that physical therapy may be more cost-effective than joint injections for treating arthritis in the longer term, despite the fact that it often has higher initial costs. However, one remaining caveat is that physical therapy is not well-suited for alleviating symptoms quickly. Further investigation should aim to determine an optimal, multimodal approach to treating arthritis over time.
References
- Rhon DI, Kim M, Asche CV, Allison SC, Allen CS, Deyle GD. Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis: A Secondary Analysis From a Randomized Clinical Trial. JAMA Netw Open. 2022;5(1):e2142709. DOI: 10.1001/jamanetworkopen.2021.42709
- Kolasinski SL, Neogi T, Hochberg MC. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology. 2020;72(2):220-233. DOI: 10.1002/art.41142
- Abbott JH, Robertson MC, Chapple C, et al. Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness. Osteoarthritis and Cartilage. 2013; 21(4):525-534. DOI: 10.1016/j.joca.2012.12.014
- Cheng OT, Souzdalnitski D, Vrooman B, Cheng J. Evidence-Based Knee Injections for the Management of Arthritis. Pain Medicine. 2012; 13(6):740–753. DOI: 10.1111/j.1526-4637.2012.01394.x