Table 2.

Non-surgical first-line approaches for management and treatment of OA and associated symptoms – from evidence-based to emerging.

Intervention type	Description
Education	Education interventions, in the form of group classes, online support, and counselling sessions, involves the provision of information to patients to ensure an understanding about OA, disease progression, and appropriate interventions and self-management options. Education is recognized as a standard of care and core component of any treatment plan for OA [57].
Exercise	Physical activity or prescribed exercise or supervised exercise programs that effectively manage symptoms of OA and play a role in prevention of OA. For OA specifically, types of exercises recommended include neuromuscular training programs (e.g. Good Living with Arthritis-Denmark (GLA:D) [58,59], aquatic exercises, strength exercises, and land-based exercise [57].
Weight management	Excess weight, and obesity in particular, are identified as a risk factor for development of OA and exacerbation of symptoms for those with an OA diagnosis. Morbid obesity has also been identified as a risk factor for complications during arthroplasty [60,61]. As such, weight loss and weight management programs that introduce various types of nutritional composition are available and recommended [57]. Many are under the supervision of a family physician or registered dietician; however, patients also opt to undertake diets independently.
Prebiotics (oral)	Many individuals with obesity have a metabolic syndrome, a syndrome which can influence the symptoms of OA. Part of this syndrome is mediated by change to the gut microbiome. However, treatment with a prebiotic such as inulin/poly-fructose can correct some of these alterations [62], and modify the metabolic syndrome and influence OA symptoms and disease progression [63].
Physical therapy	Physical therapy (or physiotherapy) is a regulated health care profession across Canada. Physical therapist are physical movement specialists, qualified to deliver interventions that aim to rehabilitate and maximize the functioning of joints and muscles [64].
Occupational therapy	Occupational Therapy is a regulated health care profession across Canada. Occupational Therapists provided a range of interventions and services to support and enable the functioning of individuals. They address physical limitations as well as psychosocial factors to enable individuals to carry out their daily activities including self-care, occupational roles and functions, educational pursuits, leisure activities and more.
Complementary and Integrative therapies	This group of therapies includes acupuncture, traditional Chinese medicine, naturopathic pharmacotherapy (e.g. vitamins, chondroitin, glucosamine) [65], variably regulated across Canada. The research evidence is limited to support the efficacy or effectiveness of these interventions; however, they are used by individuals living with OA to manage a range of symptoms, including pain and swelling related to osteoarthritis [66].
Anti-inflammatory drugs	Drugs that have active ingredients that reduce inflammation or swelling. Commonly used anti-inflammatories are non-steroidal anti-inflammatory drugs (NSAIDs) [57].
Steroids (corticosteroids, glucocorticoids)	Chemically similar to cortisol, steroids produce an anti-inflammatory and immunosuppressive response. However, frequent use via direct injection into a knee can have adverse effects, so caution is recommended [57].
Pain medications	This class of drugs blocks signals that produce pain. Examples of pain medications include acetaminophen, duloxetine, NSAIDs, aspirin [57].
Hyaluronic Acid (injections; supplements)	A treatment that introduces cross-linked hyaluronic acid into the synovial fluid of a joint such as a knee. Such HA is sold as a device to improve lubrication, but efficacy remains somewhat variable and the evidence is not strong. HA (endogenous) occurs naturally and functions as a joint lubricant. However, with OA progression, its lubricating function is negatively impacted [67,68].
Platelet-Rich Plasma (PRP) injections	Platelets in blood contain growth factors that may function to assist in tissue repair and cell regeneration. Injection of the Platelet-rich Plasma (PRP) fraction from blood into a joint has been reported to improve symptoms of OA such as pain, but results are variable and the evidence is not strong [21].