J Korean Med Assoc.  2013 Dec;56(12):1123-1131. 10.5124/jkma.2013.56.12.1123.

Pharmacologic treatment of osteoarthritis

• Baek SH
• Kim SY

• KMID: 1783727
• DOI: http://doi.org/10.5124/jkma.2013.56.12.1123

Abstract

A variety of pharmacologic agents have been developed for the treatment of osteoarthritis. At present, however, none of them has been proven to prevent disease progression, and the medications are used only for symptomatic relief. Thus, non-pharmacologic conservative treatment such as education, weight reduction in the obese, and consistent exercise should be recommended first to maintain fitness and tolerance to physical activity. Medication is then indicated to better control symptoms provided non-pharmacologic measures prove inadequate, and a successful strategy most likely would entail a combination of these non-pharmacologic and pharmacologic approaches. Acetaminophen can be tried first because of its efficacy and relatively safe profile, especially in those with mild osteoarthritis. Nonselective non-steroidal anti-inflammatory drugs may be used in patients with moderate to severe pain, but long-term medication requires caution due to the increased risk of gastrointestinal and renal complications. Selective cyclooxygenase-2 inhibitors can be better tolerated, especially in patients with risk factors for gastrointestinal adverse events, but potential cardiac and cerebrovascular thrombotic events should be considered in those with preexisting cardiovascular disease. Tramadol and opioids are more potent analgesics. However, they are not recommended for routine use due to a high incidence of nausea, constipation, and drowsiness. These agents require close monitoring for those adverse effects, especially in a geriatric population. Lastly, the pharmacologic plan should be individualized according to the severity and duration of pain, age and gender of the patient, and concurrent comorbidities to maximize the benefit as well as to minimize the risk of adverse effects from medication.

Keyword

Osteoarthritis; Pharmacologic treatment; Analgesics; Non-steroidal anti-inflammatory drugs; Disease-modifying osteoarthritis drugs

MeSH Terms

Acetaminophen
Analgesics
Analgesics, Opioid
Cardiovascular Diseases
Comorbidity
Constipation
Cyclooxygenase 2 Inhibitors
Disease Progression
Education
Humans
Incidence
Motor Activity
Nausea
Osteoarthritis*
Risk Factors
Sleep Stages
Tramadol
Weight Loss
Acetaminophen
Analgesics
Analgesics, Opioid
Cyclooxygenase 2 Inhibitors
Tramadol

Figure

• 

  Figure 1 Schematic approach for the treatment of osteoarthritis. *Gastro-protective agent: proton pump inhibitor (not prevent lower gastrointestinal [GI] complications), misoprostol, H2-receptor antagonist (high-dose famotidine only). COX, cyclooxygenase; NSAID, non-steroidal anti-inflammatory drug (From Korean Knee Society Subcommittee on Osteoarthritis Guidelines. J Korean Knee Soc 2010;22:69-74, with permission from Korean Knee Society) [6].

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