Osteoarthritis, a degenerative disease involving the breakdown of cartilage in the joints, is the most common type of arthritis people suffer from and mostly affects the elderly. Though the progression of osteoarthritis is often slow, it can be painful and debilitating. Fortunately, there are lifestyle changes that can slow its progression so people can maintain healthy and active lives.

The most common and clinically proven lifestyle approaches prescribed by physicians to slow that progression aim to reduce the inflammation resulting from cartilage damage. Recommendations may include anti-inflammatory medications, ice, exercise, stretches, massage, diet, weight loss, acupuncture, herbal remedies, joint support and pain-relieving injections. Physical therapy is often prescribed to foster correct exercise techniques. Biologic injections, such as platelet rich plasma (PRP) and stem cells, may also help diminish the pain, swelling, stiffness and other symptoms of osteoarthritis inflammation, but their level of effectiveness has yet to be definitively proven.

Supplements can help reduce inflammation, but they should be used in moderation, and people should consider consulting with a physician before self-prescribing them. Also, note there currently are no supplements known to stop the progression of osteoarthritis, such as by protecting the remaining cartilage or growing back damaged areas.

Studies show that glucosamine/chondroitin-containing supplements have anti-inflammatory characteristics similar to medications such as ibuprofen (NSAIDs) and are generally low risk. Anti-inflammatory products such as cannabidiol (CBD) oils and herbal remedies (turmeric) have also been shown to diminish some osteoarthritis symptoms. However, these supplements are often unregulated and can have unpredictable effects.

The two lifestyle factors that slow the progression of arthritis are interconnected: physical fitness and weight loss. I routinely encourage my patients to engage in regular low-impact exercises to help maintain flexibility while strengthening the muscles around the affected joint. I also promote a healthy diet to keep excess weight off. Especially in patients who are obese, losing just a few pounds can take considerable force off the joints and improve the chances of slowing osteoarthritis progression.

Unfortunately, no current medications, injections or other lifestyle modifications will change arthritis in a joint once it occurs. Certain injections, such as cortisone, have been shown in some studies to give short-term relief from symptoms but may increase the progression rate of arthritis.

It is often unpredictable how arthritis can affect a person’s quality of life. Some patients experience severe cartilage loss with bone erosion, deformity, bone spurs and mechanical symptoms, but have minimal inflammation and function quite well. Others have minimal joint damage but can have crippling inflammation, severely compromising their ability to perform the simplest of tasks. I encourage patients to carefully consider how negatively they feel their quality of life has been compromised by their osteoarthritis symptoms. When patients believe they have exhausted nonsurgical treatments, a joint replacement can be a safe and effective means to restore function, significantly decrease pain and improve physical activity.

Even so, I make it a point to never tell my patients they “need” joint replacement surgery. Patients’ own assessments of the extent to which their quality of life has been compromised will guide them in making the best decisions for themselves. I only caution against letting things go so long before making a decision that patients already are giving up activities vitally important to them or get to the point where they hardly can walk or sleep through the night because of inflammation. Likewise, patients should not wait until they are deconditioned or have progressive bone damage because this can increase the complexity of the surgery or make the recovery process more difficult or risky.

As an orthopedic surgeon, I aim to partner in the decision-making process with my patients regarding surgery. I explain the risks and benefits of joint replacement surgery related to their specific circumstances. This process leads to good and meaningful decisions about surgery, which, in turn, lead to healthier joints and happier patients. That is the gold standard when it comes to patient care.

Read: How Some Sports Injuries Can Cause Arthritis at an Early Age