Osteoarthritis: management Clinical Pharmacist, 24 APR 2015By Tina Hawkins , Andrew Barr

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Citation: Clinical PharmacistURI: 20068309

A wide range of drug classes are used in treating osteoarthritis (OA). Pharmacological therapies are adjuncts in the management of OA but there are no specific prescribing patterns because of the heterogenous nature of OA.

Joint replacement surgery (pictured) should be considered when a patient with OA suffers persistent debilitating symptoms despite treatment

Source: Luca DiCecco / Alamy

Joint replacement surgery (pictured) should be considered when a patient with osteoarthritis suffers persistent debilitating symptoms despite treatment

Summary

There are no pharmacological treatments that are known to prevent or cure osteoarthritis. Current management is directed at providing symptomatic relief. Pharmacological treatments are adjuncts that offer at best moderate symptom relief and the key to management is a combination of this with lifestyle change. Exercise regimens should include local muscle strengthening (e.g. quadriceps muscle exercises for knee OA) combined with general aerobic fitness. Ideally, patients should have an individualised exercise programme they can perform daily.

International guidelines recommend the use of topical non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol as the first-line treatment of choice. If these are inadequate, the patient should stop their current therapy and use an oral NSAID (either a non-selective or cyclo-oxygenase 2 inhibitor). Patients using oral NSAIDs should also be prescribed a proton pump inhibitor.

The use of opioids is supported in current guidance from the National Institute for Health and Care Excellence, but no reference is made to individual drugs. Opioid analgesics may be indicated for some patients with unacceptable pain despite treatment with oral paracetamol or topical NSAIDs when oral NSAIDs or COX 2 inhibitors are contraindicated.

Osteoarthritis (OA) has a broad range of presentations and therefore its potential impact on a patient’s personal life and employment can vary significantly. The management of OA must therefore be personalised and may include both pharmacological and non-pharmacological interventions. This approach has been shown to provide patients with better pain and functional outcomes[1].

The pain and disability associated with OA can have a significant impact on mood and may impair participation in both work and recreational activities. Patients should be educated about their OA and be provided with a tailored self-management plan to maintain physical function and fitness, reduce pain and prevent further deterioration.

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The confusion between Osteoarthritis and Rheumatoid Arthritis

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From: The Rheumatologist, April 2015

New Therapeutics for Osteoarthritis May Be in Sight

by Antonios Aliprantis, MD, PhD

Sebastian Kaulitzki/shutterstock.com

Image Credit: Sebastian Kaulitzki/shutterstock.com

“Doctor, I saw a commercial on TV for a new drug to treat arthritis,” is a statement I’ve heard time and again from my patients suffering with osteoarthritis (OA).

My response is universally the same, “Oooh, that’s not for you; that’s for patients with rheumatoid arthritis.” This then turns into a conversation about the differences between degenerative and autoimmune joint disease. My concluding remark is usually the same, “We don’t have anything new for your arthritis now, but we’re working on it”

Despite the fact that OA is one of the most prevalent diseases among middle-age and older adults, there are few treatment options for OA patients. We all know the therapeutic progression for knee OA, for example: weight loss and exercise, acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroid injections and some physical therapy, now and again. Go back a few decades, and the options were the same.

As we look ahead though, is there reason to believe that new therapeutics to alleviate pain and prevent further joint degeneration are on the horizon? A brief look at the modern understanding of OA progression suggests an emphatic oxymoron, “maybe, yes.”

In this article, a brief overview of OA pathogenesis frames recent discoveries suggesting that new strategies for this disease are possible.

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