29 Feb Medications Used for the Treatment of Osteoarthritis – Treatment Part 1

Unfortunately no medication has be proven to prevent the progression of Osteoarthritis (OA).  Typically I first recommend non-pharmacologic treatments.  For a discussion of this, see my previous post, http://www.nuvitalityhealth.com/arthritis-treatment-without-medication/.  If there is no inflammation, i.e. no swelling and redness, then Tylenol (Acetaminophen) is the first medicine I recommend.  As with any medication I recommend using the lowest effective dose initially, then titrate upward if needed.  A good starting dose for Acetaminophen is 325 mg three times a day.  One can titrate up to 500 mg 2 tablets 3 times a day, for a maximum dose of 3 grams a day, if there is no history of liver disease.

If Tylenol is ineffective or there is evidence of inflammation, then an NSAID such as Ibuprofen or Naproxen can be used.  I use the shorter acting NSAIDs such as Ibuprofen or Naproxen first.  It is better initially to use them on an as needed basis then titrate the dose up if needed.  Naproxen can be started at 220 mg twice a day as needed and titrated up to 500 mg twice a day.   Ibuprofen can be titrated up to 400 mg 2 tablets 3 times a day.  I recommend trying an NSAID for 4-6 weeks before deciding if it is effective.  There are notable risks when using NSAIDs chronically.  They can increase the risk of heart attacks and strokes, stomach and small intestine ulcers (Peptic Ulcer Disease),  inflammation of the stomach (Gastritis), hypertension, kidney damage, and may prevent the cardiovascular protective effects of aspirin.  Newer versions of the NSAIDs, called Cox-2 inhibitors like Celebrex, may be more protective of the stomach but the other risks are still a problem.  Of the old NSAIDs, Naproxen may have a more favorable cardiovascular risk profile.  Generally the NSAIDs have better pain control that Acetaminophen.  If you have intestinal, heart, kidney, or liver problems consult your physician before starting any medication.  Typically if NSAIDs are being used chronically your doctor will check blood counts, kidney function, and liver enzymes periodically.

If the above treatments have been ineffective or you have been unable to use either one, then the next option I have patients use are topical medications.  Diclofenac, Ibuprofen, and Ketoprofen come in topical preparations.  Topical lidocaine can be used as well.  Compounded medications that are a combination of several different medications can be obtained through your doctor.  Generally since these medications are applied topically they are considered safer to use in patients that may have contraindications to oral versions.

Capsaicin cream can be obtained over-the-counter and may be a good choice to try if the topical NDAIDs were ineffective.  The active ingredient is hot chili pepper.  It can be applied 4 times a day, but may be expensive to do so.  The most problematic side effect is local irritation (burning, stinging, and redness.)  Be careful not to apply to sensitive body parts such as the breasts, genitals, mouth, nose, and eyes.

We will discuss using steroid injections, hyulronic acid injections, and glucosamine/chondroitin in the next article.

Here’s to the Journey!