Prescribed drugs for Osteoarthritis, often simply called OA, is a common joint condition that many people might have heard of or even experienced. When someone has OA, the protective cartilage at the ends of their bones wears down over time, leading to pain, stiffness, and often difficulty moving the affected joint.
Understanding the medications used to treat OA is crucial for a couple of reasons:
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Knowing Helps in Decision-making. Just as you would want to know about the ingredients in the food you eat, understanding OA medications can help you and your doctor decide which treatment is best for you.
Safety and Well-being: Some medications might have side effects or might not work well with other medications you’re taking. Being informed can help you use medications safely and get the most benefit from them.
Pathophysiology of OA
The pathophysiology of Osteoarthritis is multifactorial, involving mechanical, cellular, and biochemical processes. The main features include:
Cartilage Degradation: The cartilage matrix, primarily made of water, collagen, and proteoglycans, starts to break down. Enzymes like metalloproteinases become overactive, leading to cartilage deterioration.
Bone Response: As the cartilage thins, underlying bone senses increased stress. This can lead to subchondral bone thickening and formation of osteophytes, or bone spurs, in an attempt to stabilize the joint.
Inflammation: Although OA is primarily a degenerative disease, inflammation plays a significant role. Synovial inflammation can cause joint swelling and pain. Over time, the release of inflammatory mediators can further damage the cartilage and underlying bone.
Changes in Joint Biomechanics: As OA progresses, the affected joints may become misaligned due to ligament laxity and muscle weakness. This misalignment can result in uneven weight distribution, exacerbating cartilage breakdown in specific areas.
Prevalence and impact on the population
Globally, OA ranks as the 11th highest contributor to disability, and the knee and hip are the most commonly affected joints. Key points regarding its prevalence and impact include:
- Aging Population: As the global population ages, the prevalence of OA is expected to rise, given that age is a significant risk factor.
- Economic Impact: OA is a leading cause of disability worldwide, leading to work limitations, early retirement, and increased healthcare costs.
- Quality of Life: Individuals with OA often experience limitations in movement, pain, and decreased overall well-being. This can impact mental health, leading to conditions like depression and anxiety.
- Rising Incidence: With increasing rates of obesity (another risk factor for OA) and longevity, more people are at risk of developing the condition.
importance of medication in the management of OA
Medications play a pivotal role in the comprehensive management strategy for OA.
- Pain Control: Effective pain management enables patients to maintain their daily activities and improves overall life quality.
- Reduction of Inflammation: Some medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), help reduce joint inflammation, alleviate pain and potentially slow disease progression.
- Disease Modifying Agents: While primarily symptomatic in approach, ongoing research is focusing on drugs that can alter or halt the disease’s progression.
- Integration with Other Therapies: Medications can enhance the effects of other therapies, such as physical therapy. For instance, pain relief from medication might enable a patient to participate more actively in exercises that strengthen muscles around the affected joints.
- Patient Empowerment: Being able to manage and mitigate symptoms gives patients a sense of control over their chronic condition, enhancing their autonomy and mental well-being.
Read More: Diet and Exercise Plans Tailored for Osteoarthritis Patients
Categories of OA Medicines
Over-the-counter (OTC) pain relievers
The vast majority of individuals with OA begin their treatment journey with OTC medications due to their accessibility and effectiveness in managing mild to moderate pain.
Acetaminophen
Mechanism: Primarily works centrally in the brain to block pain signals.
Usage: Suitable for those who cannot tolerate NSAIDs. Often recommended for mild OA pain. The first line of treatment for OA, acetaminophen, is effective for pain management but doesn’t reduce inflammation (1).
Caution: Overuse can lead to liver damage. It’s essential to avoid alcohol and other liver-taxing substances while using this medication.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Mechanism: They reduce pain and inflammation by inhibiting enzymes (COX-1 and COX-2) that produce prostaglandins, substances that mediate inflammation.
Examples:
Ibuprofen: is commonly used for pain and inflammation. It’s available in various strengths and formulations.
Naproxen: Has a longer duration of action compared to ibuprofen, often requiring fewer doses per day.
Prescription pain medications
For individuals with more severe pain or those who don’t find relief with OTC options, prescription medications may be necessary.
Stronger NSAIDs
Mechanism: Similar to OTC NSAIDs but often in higher doses or with selective action.
Examples:
Celecoxib: is a COX-2 inhibitor that targets pain and inflammation with potentially fewer gastrointestinal side effects compared to non-selective NSAIDs.
Opioids
Mechanism: Act on the central nervous system to block pain signals. They are potent analgesics.
Examples:
Tramadol: is a synthetic opioid that’s less potent than other opioids and may have a lower risk of addiction.
Oxycodone: A stronger opioid, often reserved for severe pain.
Caution: Risk of dependence, addiction, and side effects like constipation and drowsiness (2).
Duloxetine (antidepressant)
Mechanism: Primarily used for depression but also approved for chronic musculoskeletal pain. It inhibits serotonin and norepinephrine reuptake, which can modulate pain signals.
Usage: Can be particularly effective for those with concomitant depression and OA (3).
Corticosteroids
These are powerful anti-inflammatory agents.
Injections into the joint
Mechanism: Direct administration into the affected joint can rapidly reduce pain and inflammation.
Usage: Used for moderate to severe OA cases or flare-ups. The effects can last several weeks to months.
Caution: Repeated injections can potentially accelerate joint degradation (4)
Oral corticosteroids
Usage: Less commonly used for OA, but may be prescribed in short courses for severe flare-ups.
Caution: Long-term use can have systemic side effects, including weight gain, osteoporosis, and increased risk of infections.
Read More: Guide to Choosing the Right Brace for Knee OA Pain Management
Hyaluronic acid injections
In order to augment the viscous qualities of synovial fluid and possibly provide lubrication and cushioning, hyaluronic acid injections, also known as visco supplementation, entail injecting hyaluronic acid directly into the knee joint (5). Although the effectiveness of these injections varies from person to person, they may help improve joint function and lessen pain.
Topical Analgesics for OA Knee
Topical analgesics are creams, gels, or patches that are applied directly to the skin over a painful joint. They have become increasingly popular for managing osteoarthritis (OA) of the knee because they deliver medication directly to the affected area and have fewer systemic side effects compared to oral medications. Here’s a brief overview of the most commonly used topical analgesics for OA of the knee:
NSAID Gels (Nonsteroidal Anti-Inflammatory Drugs)
Examples: Diclofenac gel (e.g., Voltaren Gel)
How they work: These gels reduce inflammation and pain at the site where they’re applied. They work in a similar way to NSAID tablets but have a lower risk of side effects like stomach issues because they act locally on the affected joint (6).
Capsaicin Creams
Examples: Zostrix, Capzasin
How they work: Capsaicin is derived from chili peppers. It reduces pain by decreasing a substance in the body that helps transmit pain signals (7). It might cause a warm or burning sensation when first applied, which typically reduces with continued use.
Counterirritants
Examples: Icy Hot, Bengay, Tiger Balm
How they work: These creams or ointments create a hot or cold sensation that distracts from the deeper pain in your knee (8). They don’t necessarily treat the underlying cause of the pain but can provide temporary relief.
Lidocaine Patches
Examples: Lidoderm, Aspercreme Lidocaine Patch
How they work: Lidocaine is a local anesthetic. It acts by numbing the tissues beneath the skin. When applied as a patch, it can help numb the affected area, providing relief from OA pain (9).
Salicylates
Examples: Aspercreme, Bengay
How they work: Salicylates can reduce pain and inflammation by inhibiting a specific enzyme. When applied to the skin, they can help relieve pain in the underlying joint (10).
Advantages of Topical Analgesics
- Direct application to the painful area.
- Reduced systemic side effects as compared to oral medications.
- Suitable for individuals who can’t take oral medications due to other health issues (6).
Things to Note
- Always read the label and use as directed.
- It’s essential to avoid applying them to broken skin or open wounds.
- If using a topical analgesic, avoid heating pads on the same area, as this can intensify the effect and potentially cause burns.
- It’s a good idea to discuss with a healthcare provider before starting any new medication, even over-the-counter topical treatments.
Disease-modifying OA drugs (under research and development)
These drugs aim to not just alleviate symptoms but also modify the course of the disease, potentially slowing or even reversing cartilage degradation.
Note: As of the last update, there are several potential disease-modifying drugs in clinical trials. It’s crucial to stay updated with the latest research findings in this area.
Read More: How Effective is PRP in Addressing Knee Osteoarthritis Symptoms?
Benefits and Limitations of OA Medicines
Analgesic effect
Pain relief is the primary benefit most individuals seek from OA medications, and many drugs can provide significant relief.
Short-term versus long-term relief
Short-term Relief: Many over-the-counter and prescription drugs, especially NSAIDs and acetaminophen, offer immediate pain relief. Their action begins soon after ingestion and can last for several hours.
Long-term Relief: Corticosteroid injections, hyaluronic acid injections, and certain pain medications can provide pain relief lasting several weeks to months. These options are especially beneficial for those with chronic, severe pain.
Reducing inflammation
Many OA medications target inflammation, which is a significant source of pain and further joint damage.
Benefit: Reduced inflammation can lead to less pain and improved joint function. It may also slow down the progression of OA.
Limitation: Some anti-inflammatory medications, like NSAIDs, might only mask the symptoms without addressing the underlying causes of inflammation.
Side effects and risks
Like all medications, OA drugs can have side effects and associated risks.
Gastrointestinal problems
- NSAIDs, especially when taken in high doses or for extended periods, can cause stomach upset, ulcers, and bleeding (11).
- Protective agents or co-prescribed medications can sometimes minimize these risks.
Cardiovascular risks
Some NSAIDs have been associated with an increased risk of heart attack, stroke, and hypertension. This has led to the recommendation that NSAIDs be used at the lowest effective dose for the shortest period (12).
Dependence and addiction (with opioids)
- Opioids, even when taken as prescribed, carry the risk of dependence and addiction.
- Their use should be carefully monitored, and they should be prescribed as a last resort for pain control when other medications fail.
- Additional risks include respiratory depression, constipation, and potential overdose.
Interactions with other medications
One significant limitation of many OA drugs is their potential to interact with other medications, potentially reducing their efficacy or increasing the risk of side effects.
NSAIDs: Can interact with blood thinners, blood pressure medications, and certain kidney medications.
Acetaminophen: Chronic use with alcohol or other liver-affecting drugs can increase the risk of liver damage.
Opioids: Can cause respiratory depression when taken with other central nervous system depressants like alcohol, benzodiazepines, or certain sleep aids.
Duloxetine: Can interact with other antidepressants, certain migraine medications, and blood thinners.
The Future of OA Medication
As osteoarthritis remains a prevalent condition impacting millions worldwide, the scientific community is tirelessly working towards developing innovative treatments that not only manage symptoms but also target the underlying causes and potentially reverse the progression of the disease.
New research directions
Biological treatments
Overview: These treatments involve using natural substances, like cells or proteins, to treat or prevent disease. For OA, the focus is mainly on treatments that can promote joint repair and reduce inflammation.
Examples:
Stem Cell Therapy: Using stem cells derived from a patient’s body or other sources to promote cartilage regeneration.
Platelet-rich Plasma (PRP) Injections: Using a concentration of the patient’s own platelets to boost the body’s natural healing process.
Potential Benefits: Can provide long-term relief, slow or halt the disease progression, and, in some cases, aid in cartilage regeneration.
Challenges: Requires further research to standardize treatment protocols, determine the best candidates, and understand the long-term effects.
Gene therapy
Overview: To treat or prevent disease, this method entails changing the genes within the body’s cells.
Potential Application in OA: Targeting genes responsible for cartilage degradation or inflammation or enhancing genes that promote cartilage synthesis and repair.
Benefits: If successful, gene therapy could potentially reverse the course of OA or even provide a cure.
Challenges: Gene therapy is still in its infancy, especially for conditions like OA. There are ethical concerns, potential side effects, and the challenge of ensuring targeted and efficient delivery.
“SDM”: The Best for Treatment for Osteoarthritis
Structural Diagnosis and Management (SDM) stands out as a pioneering approach in the realm of physiotherapy techniques for treating Osteoarthritis. At its core, SDM incorporates a specialized manual technique that holistically addresses joint and muscle issues. It delves into manipulation to adjust misaligned joints, employs muscle activation to stimulate dormant or weak muscles, and incorporates stretching to enhance flexibility and reduce stiffness. The technique of muscle press-pull ensures optimal muscle balance, while strengthening exercises bolster muscle support around affected joints. Furthermore, joint mobilization plays a crucial role in SDM by restoring natural movement and alleviating pain. So, why choose Agrani Specialized Manipulation Therapy Center for SDM? Beyond the expertise in implementing this innovative technique, ASPC offers a tailored approach, ensuring every patient receives personalized care. Their adept professionals are trained in SDM, making it an ideal choice for those seeking effective relief from the discomforts of Osteoarthritis. Prescribed drugs
Conclusion
Medicine is a field that’s always progressing, and when it comes to OA, things are no different. If we took a step back in time, we’d see that we had far fewer options for treating OA than we do now. This is promising news! Today, thanks to ongoing research and innovation, new and potentially more effective treatments are emerging. Some of these, like using our own body’s natural materials (like stem cells) or even exploring ways to modify our genes, sound like they’re straight out of a science fiction novel. But they’re becoming real possibilities. Prescribed drugs
However, with every new discovery, it’s essential to stay informed and understand both the potential benefits and challenges. After all, not every new treatment will be a good fit for everyone. By working closely with healthcare professionals and staying updated on the latest advancements, those with OA can navigate this evolving landscape and make choices that best suit their needs. Prescribed drugs
FAQ’s
What are the most commonly prescribed medications for osteoarthritis (OA)?
The most commonly prescribed medications for OA include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and in more severe cases, opioids. Other treatments like hyaluronic acid injections and corticosteroids might also be used.
Are over-the-counter (OTC) pain relievers effective for OA?
Yes, OTC pain relievers like acetaminophen and non-prescription NSAIDs can be effective for mild to moderate OA pain. However, it’s crucial to follow the recommended dosage and consult with a healthcare professional about long-term use.
How do NSAIDs work in treating osteoarthritis symptoms?
NSAIDs work by reducing the production of substances in the body that cause inflammation and pain. They can offer relief from both pain and inflammation commonly associated with OA.
Are there any side effects associated with OA medications?
Yes, like all medications, OA drugs can have side effects. For example, NSAIDs can cause stomach problems, cardiovascular issues, and liver and kidney damage with prolonged use. It’s essential to be aware of potential side effects and discuss them with your healthcare provider.
Can opioids be prescribed for severe OA pain?
Yes, opioids can be prescribed for severe OA pain, especially when other treatments haven’t been effective. However, they should be used with caution due to the risk of dependence and side effects.
Are there any topical treatments for OA?
Yes, there are several topical treatments available, including NSAID gels, capsaicin creams, and lidocaine patches. These can be applied directly to the affected joint for pain relief.
How often should I take my OA medications?
The frequency of medication intake will depend on the specific drug, its dosage, and the recommendations of your healthcare provider. Always follow the prescribed regimen and consult with your doctor about any concerns.
Can I combine different OA medications?
It’s essential to consult with a healthcare professional before combining medications, as there can be interactions that might reduce their efficacy or increase side effects.
References
1. Towheed, T., Maxwell, L., Judd, M., Catton, M., Hochberg, M.C., and Wells, G.A., 2006. Acetaminophen for osteoarthritis. Cochrane database of systematic reviews, (1).https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004257.pub2/abstract
2. da Costa, B.R., Nüesch, E., Kasteler, R., Husni, E., Welch, V., Rutjes, A.W., and Jüni, P., 2014. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews (9).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003115.pub4/abstract
3. Chappell, A.S., Desaiah, D., Liu‐Seifert, H., Zhang, S., Skljarevski, V., Belenkov, Y., and Brown, J.P., 2011. A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Practice, 11(1), pp. 33–41.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1533-2500.2010.00401.x
4. Towheed, T.E., 2005. Systematic review of therapies for osteoarthritis of the hand. Osteoarthritis and Cartilage, 13(6), pp. 455–462. https://www.sciencedirect.com/science/article/pii/S1063458405000579
5. Bellamy, N., Campbell, J., Welch, V., Gee, T.L., Bourne, R., and Wells, G.A., 2006. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane database of systematic reviews, (2).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005321.pub2/abstract
6. Derry, S., Conaghan, P., Da Silva, J.A.P., Wiffen, P.J., and Moore, R.A., 2016. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews, (4).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007400.pub3/abstract
7. Laslett, Laura L., and Graeme Jones. “Capsaicin for osteoarthritis pain.” Capsaicin as a Therapeutic Molecule (2014): 277–291. https://link.springer.com/chapter/10.1007/978-3-0348-0828-6_11
8. Higashi, Y., Kiuchi, T., and Furuta, K., 2010. Efficacy and safety profile of a topical methyl salicylate and menthol patch in adult patients with mild to moderate muscle strain: a randomized, double-blind, parallel-group, placebo-controlled, multicenter study. Clinical Therapeutics, 32(1), pp. 34–43. https://www.sciencedirect.com/science/article/pii/S0149291810000172
9. Gammaitoni, A.R., and Davis, M.W., 2002. Pharmacokinetics and tolerability of lidocaine patch 5% with extended dosing. Annals of Pharmacotherapy, 36(2), pp. 236-240.
https://journals.sagepub.com/doi/abs/10.1345/aph.1A185
10. Altman, R.D., and Barthel, H.R., 2011. Topical therapies for osteoarthritis. Drugs, 71, pp. 1259–1279.
https://link.springer.com/article/10.2165/11592550-000000000-00000
11. Bhala, N., Emberson, J., Merhi, A., Abramson, S., Arber, N., Baron, J.A., Bombardier, C., Cannon, C., Farkouh, M.E., FitzGerald, G.A., and Goss, P., 2013. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet (London, England), 382 (9894), pp. 769–779.
https://europepmc.org/article/pmc/pmc3778977
12. McGettigan, P., and Henry, D., 2011. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS medicine, 8(9), p.e1001098.
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001098
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd
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