Novelties in the treatment of osteoarthritis

Abstract

Goal of osteoarthritis (OA) treatment is to relieve the pain and to reduce the loss of patient's physical functionality. Therapy consists of: nonpharmacological measures, pharmacotherapy and surgery. Although nonpharmacological approach represents a basis of OA treatment, pharmacotherapy is an important adjunct. Medications that are used in this disease can be administered orally, topically or intra-articularly. In OA treatment the following medications are used: analgesics, glucosamine- and chondroitin-based preparations, glucocorticoids and hyaluronic acid (intra-articular administration) and other medications. Nonopioid analgesics represent a corner stone in OA pharmacotherapy. Treatment initiation with paracetamol (acetaminophen) and/or topical nonsteroidal anti-inflammatory drug (NSAID) is recommended. Afterwards, in a case of complete or partial treatment failure, oral traditional NSAID (tNSAID) or selective COX-2 inhibitor should be used, or opioids as a substitute or an adjunct. Glucosamine- and chondroitin-based preparations are not recommended for OA treatment. Intra-articular use of glucocorticoid (triamcinolon) can lead to short lasting removal of pain and inflammation, while intra-articular use of hyaluronic acid is not recommended. Surgical treatment is important for heavy joint damage and in the case of failure of other treatment modalities.