Pharmacologic treatment of hand-, knee- and hip-osteoarthritis

Abstract

Osteoarthritis (OA) is a joint disease of high prevalence and affects > 90 % of the population, depending on several risk factors. Symptomatic OA is less frequent, but requires an individually tailored therapeutic regimen consisting of non-pharmacological and pharmacological treatment modalities. Pharmacologic therapy, however, is mainly limited to analgetic and anti-inflammatory agents; structure modifying remedies do not exist. The therapeutic approach to hand-, knee- and hip-OA is basically similar and differs only at some minor points. Generally, topical agents or paracetamol are recommended as first-line agents. If unsuccessful oral non-steroidal anti-inflammatory drugs (NSAIDs) or COX-2-selctive inhibitors should be introduced. Tramadol is an option in the case patients will not respond satisfactorily to NSAIDs. Glucosamine and chondroitine sulphate are no longer recommended in knee and hip OA, but chondroitine might be efficient in treating hand OA. Oral NSAIDs should be prescribed with caution due to potential side effects. Opioids are not recommended as their benefits are outweighed by an increased risk for serious adverse events.

Thai Massage, and Thai Herbal Compress versus Oral Ibuprofen in Symptomatic Treatment of Osteoarthritis of the Knee: A Randomized Controlled Trial

“…The knee is regarded as one of the most common joints frequently affected by OA [4]. The purposes of symptomatic treatment of OA of the knee are to control joint pain and to improve joint function [3].…”

“…The purposes of symptomatic treatment of OA of the knee are to control joint pain and to improve joint function [3]. The well-known pharmacological approach for symptomatic treatment includes oral administration of paracetamol, NSAIDs, opioids, and intra-articular corticosteroid injections [3, 4]. Although paracetamol should be prescribed as the preferred oral analgesic [5], it has been reported that the majority of patients with OA would prefer NSAIDs to paracetamol [6, 7].…”

How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts

“…If symptoms do not improve after an extended period of nonpharmacological therapy (generally 3–6 months), pharmacological add-on treatments (Table 1) are recommended, which can be combined where appropriate [Crawford et al 2013; McAlindon et al 2014]. Acetaminophen, oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 (COX2) inhibitors, disease-modifying drugs and opioids are regularly prescribed for short-term management of OA pain; however, evidence regarding their efficacy is increasingly being questioned, due to their risk for serious adverse events [Bobacz, 2013; Bannuru et al 2015; Fibel et al 2015].…”

<p>Periarticular hypertonic dextrose vs intraarticular hyaluronic acid injections: a comparison of two minimally invasive techniques in the treatment of symptomatic knee osteoarthritis</p>

“…KOA treatment begins by nonpharmacological treatments, focuses on joint-unloading therapies, and includes weight loss, exercise, physiotherapy, and orthotic devices 3,4. Pharmacological add-on regimens such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 (COX2) inhibitors, and disease-modifying drugs were prescribed regularly for short-term pain management, if symptoms do not 5,6…”