J Korean Med Assoc.  2024 Oct;67(10):635-640. 10.5124/jkma.2024.67.10.635.

Pharmacological management of osteoarthritis: judicious use of nonsteroidal anti-inflammatory drugs

• Lee H

• KMID: 2560527
• DOI: http://doi.org/10.5124/jkma.2024.67.10.635

Abstract

Background
Osteoarthritis (OA) is a chronic disease characterized by persistent pain and joint deformation. Effective pain management in patients with OA necessitates accurate diagnosis and appropriate treatment planning, considering the prolonged therapy required for OA. Although non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management in patients with OA, their long-term use can lead to various adverse effects that warrant careful consideration.
Current Concepts
NSAIDs inhibit cyclo-oxygenase (COX) enzymes and produce an anti-inflammatory and analgesic effect. However, this mechanism of action can produce adverse gastrointestinal, cardiovascular, and renal effects. The relative risk of gastrointestinal and cardiovascular adverse events depends on the COX selectivity of NSAIDs. Consequently, selective COX-2 inhibitor or concomitant proton pump inhibitor administration is recommended in patients at a high risk of gastrointestinal complications. Minimizing NSAID use is advised in patients at a high risk of cardiovascular adverse events; however, if this is unavoidable, short-term administration of naproxen or low-dose celecoxib should be considered. COX selectivity is not associated with adverse renal events. Therefore, acetaminophen is preferred in patients with impaired renal function, and short-term use of NSAID patches or topical formulations may be useful.
Discussion and Conclusion
The choice of NSAIDs for OA should be tailored to patients’ needs, considering their risk factors, potential drug interactions, and other relevant factors. Additionally, incorporation of nonpharmacological interventions can minimize the NSAID dosage and reduce the risk of adverse effects, and regular monitoring is essential to identify adverse effects.

Keyword

Adverse effects; Cyclooxygenase inhibitors; Nonsteroidal anti-inflammatory agents; Osteoarthritis; Pain management; 부작용; 사이클로옥시게나제 억제제; 비스테로이드성 항염증제; 골관절염; 통증 관리