Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis

Abstract

Osteoarthritis (OA) is not merely a degenerative disease but a disease of the whole joint. The aims of OA treatment are to alleviate pain and to improve function. The effect of pharmacologic and non-pharmacologic treatment in OA as shown by randomized control trials (RCTs) is often small or moderate. The treatment should be therefore personalized since not every patient will benefit from a specific treatment. The combination of non-pharmacologic with pharmacologic treatment will give the best result. It is important to educate the patient about the aim of OA treatment to increase therapeutic adherence. Since obesity is one of the most important risk factors for having OA progression, losing weight should be advised. Losing weight can be achieved by diet or by performing exercise. Exercise without joint movement (isometric exercise) should be tried first in patients who cannot perform high-impact exercise. When pain is bearable and joint function is not severely limited, isotonic exercise such as walking, biking, and swimming can be prescribed. The first-line pharmacologic OA treatment is acetaminophen to treat mild and intermittent symptoms. If the symptoms are getting worse or when acetaminophen is not sufficient to relieve pain, non-steroidal anti-inflammatory drugs (NSAIDs) can be used. Risk profile of having gastric ulcer complication and cardiovascular risk factor should be assessed prior to prescribing NSAIDs. In case of refractory pain after non-pharmacologic and pharmacologic treatment, total joint replacement (TJR) can be considered. The patient should be willing to have surgery and have no relative contraindication. Morbid obesity might be a contraindication for TJR. Studies on drugs that not only improve symptoms but also halt further damage of the joint, the so-called disease-modifying OA drugs, are ongoing. Several examples of the drugs are anakinra, adalimumab, and doxycycline. At present, there is no solid evidence whether these drugs can indeed be used as disease-modifying osteoarthritis drugs (DMOADs).