Osteoarthritis which is also known as osteoarthrosis or degenerative joint disease is a progressive disorder of the joints caused by gradual loss of cartilage which results to the development of bone spurs (or abnormal bony growth) and/or cysts at the margin of the joints. It occurs when the protective cartilage on the ends of the bones wears down over time.
Osteoarthritis can damage any joint in the body, however, the disorder most commonly affects the joints in your hands, knees, hips and spine.
- Primary osteoarthritis - is mostly related to aging. As you age, the water content of the cartilage increases while the protein content of the cartilage degenerates. Repetitive use of the joints over the years causes damage to the cartilage.
- Secondary osteoarthritis - caused by other conditions such as rheumatoid arthritis or other inflammatory arthritis, trauma, metabolic or endocrine disorders and congenital factors.
Commonly Prescribed Drugs
It is commonly recommended as first-line drug therapy for pain management of osteoarthritis. Paracetamol is usually well tolerated but potentially fatal hepatotoxicity with overdose is well documented. Use with caution to patients with liver disease and those who chronically abuse alcohol.
- Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs at prescription strength are often prescribed to patients after treatment with paracetamol proves ineffective. All NSAIDs have similar efficacy in reducing pain and inflammation in osteoarthritis although individual patient response differs among NSAIDs. Gastrointestinal disturbances are the most common side effects of NSAIDs use, thus, it should be taken with food or milk to minimize gastrointestinal irritation, Drugs: Coxibs, ibuprofen, mefenamic acid, diclofenac, naproxen
- Topical Therapies
- Capsaicin - Extract of red peppers that causes release and ultimately depletion of substance P from nerve fibers, has been beneficial in providing pain relief in osteoarthritis when applied topically over affected joints. It may be used alone or with oral analgesic or NSAID's. For first time users, apply it in a small area of skin to make sure there is no allergic reaction. It may be used 3 or 4 times daily. Patient may notice a burning sensation after use.
- Topical diclofenac - Diclofenac has analgesic, anti-inflammatory and antipyretic properties and has shown to be effective in treating a variety of acute and chronic pain and inflammatory conditions.
- Topical rubefacients containing methyl salicylate, trolamine salicylate and other salicylates.
- Nutritional supplements
Glucosamine and chondroitin are nutritional supplements used as adjunct in the therapy of osteoarthritis. Glucosamine adverse effects are mild and include gastrointestinal gas, bloating and cramps. It should not be used in patients with shellfish allergies. On the other hand, nausea is the most common adverse effect of chondtroitin.
Intraarticular corticosteroid injections can induce relief, particularly when a joint effusion is present. Therapy is limited to three or four injections per year due to its potential systemic effects and because the need for more frequent injections indicates poor response to therapy. Drugs: Methylprednisolone acetate, triamcinolone
- Hyaluronate injections
The normal cartilage constitutes by high-molecular weight hyaluronic acid which provides lubrication with motion and shock absorbency during rapid movements. It may temporarily and modestly increase synovial fluid viscosity and were reported to decrease pain Drugs: Sodium hyaluronate, hylan polymers
- Opioid analgesics
Low-dose opioid analgesics may be useful for patients who experienced no relief with paracetamol, NSAIDs, intraarticular injections or topical therapy. They are also useful in patients who cannot take NSAIDs because of renal failure or who are at high surgical risk to prevent joint arthroplasty. Drugs: Oxycodone, tramadol