1. Medications for Osteoarthritis:
Relieving the Pain
Developed by:
Eugene B Smith Jr, PharmD , MPH, Associate Professor
Laura Jones, MPH, Extension Assistant
Bobbi Clarke, PhD, RD, Professor and Extension
Health Specialist
UT Center for Community Health Literacy

2. What is Osteoarthritis?
Osteoarthritis (OA) is the most common form of arthritis
It is the progressive loss of cartilage in the joints
OA is also known as “degenerative joint disease”
Over 60% of people over 65 have some form of arthritis
Cartilage is the slippery material that cushions the ends of the bones in the joint.
Many different types of arthritis- this information is meant to specifically refer to OA.

3. Osteoarthritis Pain
The motivation for most OA therapy is pain improvement/relief
This cycle represents common problems that can make pain worse
You can break the cycle at any point with a variety of self-help strategies
Pain does not have to control your life
The Cycle of Pain
Disease
Fatigue
Tense Muscles
Depression
Stress/Anxiety
Difficult
Emotions

4. Breaking the Pain Cycle
The Arthritis Self-Help Program is designed to present practical ways that you can break the arthritis pain cycle and regain control of your pain, such as:
Exercise
Adequate rest
Healthy diet/weight loss
Relaxation Techniques
Positive Self Talk
Mental techniques to fight pain
Physical Therapy
Drug therapy
Surgery

5. Exercise and Weight Loss
One of the most effective ways to help arthritis!
Helps reduce stiffness, increases flexibility and prevents falls
Weight Loss:
Research studies have shown that even a 10% loss of weight can improve OA symptoms by 50%!!
Exercise is very important for the treatment of OA. Part of the goal of drug therapy is to relieve pain so that you can exercise the way you want to.

6. Drug Therapy
Medications are an important strategy for breaking the pain cycle
Keep in mind- unfortunately, we do not have any drugs that reverse the progression of OA
The main goal of drug therapy:
To relieve pain and help patients exercise and keep the joints functioning

7. Drugs used for OA Acetaminophen Topical pain relievers
Non Steroidal Anti-inflammatory Drugs (NSAIDs)
Corticosteroids
Hyaluronic acid
Narcotic pain relievers

8. Acetaminophen
Acetaminophen (Tylenol) is available OTC and has been the best drug for treating the pain of OA for a long time
Be careful to use the right dose:
Read the dosage on the package carefully
Start with small doses even as little as one 500mg dose can be effective
Do not exceed 4000 mg in any daily dosage.

9. Use Caution…
Sometimes people develop a tolerance to pain relievers and need a higher dose to relieve the pain
Doses over 4000 mg/day of Acetaminophen damage the liver and can cause death!
Many drugs contain Acetaminophen. Be sure to read labels and know how much you are getting in a day from all your medications
Long term use may also cause Kidney damage:
The July 26,2004 issue of Archives of Internal Medicine reported that long-term habitual use of acetaminophen may cause a decline I kidney function in some people. Overall one in 10 of the 1700 women studied over 11 years experienced a 30% decline in GFR
In the study , women who had taken between 1500 and 9000 tablets over their lifetime raised their risk of kidney impairment by 64%
For those who took more than 9000 tablets , their risk more than doubled

10. Topical Treatments
There are a variety of things that can be applied to the affected joint that will relieve pain:
Heat and ice
Lidocaine patches
Topical NSAIDS (not for long-term relief)
Capsaicin (Zostrix)
A skin cream made from hot peppers that relieves pain and possibly reduces inflammation over time

11. The Clock is Ticking…
Studies show that Topical NSAIDs used in OA are only effective during the first 2 weeks of therapy!!

12. Glucosamine & Chondroitin
Are they effective when taken together??
Many patients claim they help
Some studies have shown slowed progression of joint disease
However, other studies have shown only limited effectiveness in treating pain
Such as the NIH GAIT study which showed them to be better than placebo (60% improvement compared to 50% for placebo)

13. Glucosamine
In the US, Glucosamine is considered a dietary supplement (not a drug) and does not have to be proven to be effective to be sold
Worstpills.org (a Consumer Reports website) advises consumers to avoid glucosamine due to lack of proven effectiveness

14. What if I decide to give it a try?
Buy a supplement that contains glucosamine only- it will be cheaper and no studies have shown chondroitin to be effective by itself
You should try it for a minimum of 8 weeks and keep a diary to see if you are feeling better
Buy a tested brand:
See for comparisons

15. NSAIDS “NSAID” stands for: Non-Steroidal Anti-Inflammatory Drug(s)
Different classes of NSAIDS:
Non-selective NSAIDS:
Ibuprofen (OTC)
Naproxen (OTC)
Indomethacin (Must be prescribed)
Selective “COX-2” inhibitors:
Celebrex , Vioxx, and Bextra
General NSAIDS inhibit both COX-1 and COX-2. Inhibition of COX-1 produces the undesirable effect of stomach ulcers.

16. Are NSAIDs Safe?
In general, NSAIDS are good class of drugs because they treat pain and reduce inflammation
Negative side effects:
Non-selective NSAIDS
Stomach upset/bleeding/ulcers
Selective “COX-2” drugs:
Possibly increase heart attack/disease risk

17. FDA Verdict on Cox-2 Drugs
In 2005, the FDA recommended that warnings appear on the labels of Selective Cox-2 inhibitors concerning their heart risks and requiring each prescription to have a guide describing the risks
They recommended that non-selective NSAIDS carry the same warnings
Fate of Cox-2 Inhibitors:
Vioxx and Bextra were taken off the market
Only Celebrex remains

18. Corticosteroids
These drugs are naturally occurring substances in the body but as drugs they have been further refined to make them more effective. Examples:
Prednisone , Hydrocortisone, Betamethasone, Methylprednisiolone, Triamcinolone,etc
They can be used orally or by injection for OA. They have significant side effects so they should used sparingly (intra-articular injection every 3-6 months)

19. Hyaluronic acid
This agent is used by injection into the joints in patients with severe disease and has many advantages but must also be used sparingly. It is used to replace lost fluid in the joint spaces and keep the joint working to cushion the bones in the joint.

20. Narcotic pain relievers
These drugs are reserved for moderate to severe pain after the other options have not worked. Why?:
They make you sleepy and this reduces the ability to drive, work, or exercise
Side effects include: anxiety, constipation, nausea and vomiting, & urinary retention
Tolerance develops soon and treating OA is a lifetime process

21. Conclusion
The use of drugs for OA is a proven treatment approach. Recent news releases have reminded us that drugs in these classes have significant side effects that we must be concerned about when we use these drugs.
Take care to use drugs wisely!