- 8 Downloads
Osteoarthritis, the most common rheumatic disease, presents the clinician with a major therapeutic and management task. The chronic and progressive course of the disease is punctuated by pain, declining function and escalating disability. This article attempts to deal with the pharmacological therapeutic options available to us in the management of osteoarthritis. Other non-pharmacological therapeutic modalities are also briefly discussed, including patient education, joint protection, physiotherapy, occupational therapy and surgery. Drug therapy as discussed focuses on the control of pain and inflammation.
For this intermittently painful condition analgesic drugs assume a very important role. Non-steroidal anti-inflammatory drugs (NSAIDs) have combined analgesic and anti-inflammatory properties which are particularly useful in many patients who manifest inflammation in addition to pain. While systemic steroids have no role in the treatment of osteoarthritis, intra-articular steroid injections may be of benefit. In trying to slow the degenerative process chondroprotective agents such as glycosaminoglycan may also assume increasing importance in the future. Choosing one drug over another must be done after consideration of many factors including the therapeutic and toxicity profile of the drugs involved, their pharmacology and dose regimen, the patient profile, cost and the desired effect.
KeywordsOsteoarthritis Piroxicam Sulindac Tiaprofenic Acid Fenoprofen
Unable to display preview. Download preview PDF.
- Agrawal NM, Dajani EZ. Options in the treatment and prevention of NSAID-induced gastro-duodenal mucosal damage. Journal of Rheumatology 17 (Suppl. 20): 7–11, 1990Google Scholar
- Behrens F, Shepard N, Mitchell N. Metabolic recovery of articular cartilage after intra-articular injection of glucocorticords. Journal of Bone and Joint Surgery 58A: 1157–1160, 1976Google Scholar
- Fuji K, Tajiri K, Kajiwara T, Tanaka T, Murota K. Effects of NSAID on collagen and proteoglycan synthesis of cultured chondrocytes. Journal of Rheumatology 16 (Suppl. 18): 28–31, 1989Google Scholar
- Gatter RA. Arthrocentesis technique anmd intrasynovial therapy. In McCarty DJ (Ed.) Arthritis and allied conditions, 11th ed., pp. 646–656, Lea & Febiger, Philadelphia, 1989Google Scholar
- Hoaglund FT, Yau ACMC, Wong WL. Osteoarthritis of the hip and other joints in Southern Chinese in Hong Kong. Journal of Bone and Joint Surgery 55A: 645–657, 1973Google Scholar
- Hurkisson EC, Doyle DV, Lanhan JG. Drug treatment of osteoarthritis. Clinics in Rheumatic Diseases — Osteoarthritis. 2(2): 421–431, 1985Google Scholar
- Jaffe JH, Martin WR. The pharmacological basis of therapeutics, 7th ed., pp. 491–581, MacMillan Publishing Company, 1985Google Scholar
- Mankin HJ. Kelley’s textbook of rheumatology. 3rd ed., pp. 1480–1510, W.B. Saunders, 1989Google Scholar
- Mankin HJ, Conger KA. Acute effects of intra-articular hyflrocortisone on articular cartilage in rabbits. Journal of Bone and Joint Surgery 48A: 1383–1388s 1986Google Scholar
- Moskowitz RW, Brandt KD. In McCarty DJ (Ed.) Arthritis and allied conditions, 11th ed., pp. 1605–1641, Lea & Febiger,1989Google Scholar
- Moskowitz RW, Goldberg V, Schwab W. Effects of intra articular cortico-steroids and exercise in experimental models of inflammatory and degenerative arthritis. Arthritis and Rheumatism 18: 417, 1975Google Scholar
- Mukhopadhaya B, Baroodh B. Osteoarthritis of hip in Indians: an anatomical and clinical study. Indian Journal of Orthopaedics 1: 55–62, 1967Google Scholar
- Neustadt DH. Intra-articular therapy for rheumatoid synovitis of the knee: effect of the post injection rest regimen. Clinical Rheumatology in Practice 3: 65–68, 1985Google Scholar
- Neustadt DH. Intra-articular therapy. In Schumacher HR et al. (Eds) Primer on rheumatic diseases, 9th ed., pp. 294–296, Arthritis Foundation, Atlanta GA, 1989Google Scholar
- Paulus H. In Schumacher HR et al. (Eds) Primer on rheumatic diseases, 9th ed., pp. 282–288, Arthritis Foundation, Atlanta GA, 1989Google Scholar
- Pelletier JP, Martel-Pelletier J. Evidence for the involvement of interleukin 1 in human osteoarthritic cartilage degradation: protective effect of NSAID. Journal of Rheumatology 16 (Suppl. 18): 16–27, 1989Google Scholar
- Waisen TA, McCauley FA, Wilson TW. Sulindac does not spare renal prostaglandins. Clinical and Investigative Medicine 12(2): 77–81, 1989Google Scholar