Medications for Osteoarthritis (OA)

Introduction

Aches and pains can sometimes persist despite implementing consistent lifestyle changes. As discussed previously, there are numerous treatments for worn-out knees and hips which don’t require you to see a doctor. These include exercise, weight loss and external aids. If pain continues to affect your quality of life, however, you might consider consultation with a medical professional to discuss medical interventions.

Some medical interventions require a prescription, others do not. All have risks and benefits, which require consultation and monitoring by a doctor. Read on to learn more about osteoarthritis and the risks and benefits of medication.

What is osteoarthritis (OA)?

OA is a common cause of pain and altered joint function in adults.(1) The knee is the most common joint affected.(2) OA was previously considered to be the result of ‘wear and tear’, but current research suggests that underlying inflammation affects all components of the joint, including joint surface cartilage, nearby bone, the joint capsule and surrounding soft tissues.(3) Damage to the joint organ manifests as worsening pain, tenderness, reduced range of motion, bony swelling, joint deformity and instability.(4) Fortunately, lifestyle changes, such as weight loss, exercise and external aids can improve joint pain and function. In some cases, additional medical treatment is required to reduce symptoms from OA.

Medications for OA

It is important to note that medication works best in conjunction with lifestyle measures.(5) Medications for OA are often used to increase mobility and reduce pain, so that patients can maintain active, healthy lifestyles. Medications do not treat the disease itself, but instead help you to manage the symptoms of OA. The below section discusses the benefits, risks and recommended use of a number of common medications and dietary supplements.

Topical anti-inflammatories

Inflammatory chemicals produced by your body cause pain, redness, swelling, heat and loss of function. Anti-inflammatory medications, such as diclofenac and ketoprofen, reduce the production of a number of inflammatory chemicals, which in turn can reduce pain.(6) A large review found that three in five patients achieve a 50% improvement in pain when applying an anti-inflammatory gel over knee and hand joints affected by OA.(6) The anti-inflammatory gel performed better than a normal gel, which did not contain anti-inflammatory medication.(7) The anti-inflammatory gel also performed just as well as anti-inflammatory tablets.(6) The gel form does not have the same gut, kidney or heart side effects as the tablet form.(8)

Oral anti-inflammatories

Patients who do not improve with topical anti-inflammatories, or who have OA in multiple joints or in their hip may also trial anti-inflammatory tablets.(6) These tablets work in a broader fashion than the gel to reduce your body’s inflammation and pain from OA.(6, 9, 10) As there is a risk of gut, kidney and heart problems when on these tablets in the long term, a doctor should monitor patient suitability, dose, duration and side effects.(11-16)

Topical capsaicin

Capsaicin is derived from hot chilli peppers and seems to alleviate pain transmission in mild OA.(17, 18) Application of capsaicin gel at the site of knee pain was more effective than normal (non-capsaicin) gel in a number of small studies, with benefits lasting for 12 weeks.(18, 19) The most common side effect is a local burning sensation, which occurs in over half of patients, but improves with prolonged use. Topical capsaicin has no effect on the gut, kidneys or heart.(5, 19, 20)

Duloxetine

Some patients cannot take anti-inflammatory tablets due to medical conditions. Others do not respond to first-line medications for OA. These people may benefit from a type of antidepressant called duloxetine.(21) Duloxetine increases brain chemicals that can inhibit pain signals travelling from your joints. Several trials have revealed that duloxetine decreases pain intensity by 30 to 50%.(22) Duloxetine dose should be monitored closely by a doctor. Side effects include nausea, fatigue, constipation, dry mouth, diarrhoea, sleepiness and dizziness.(21)

Glucocorticoid (cortisone) injections

Glucocorticoid injections provide pain relief in OA but should not occur routinely. Some evidence suggests that glucocorticoid injections on a regular basis can increase the joint cartilage damage in OA.(23) This treatment may be suitable for patients in high levels of pain who are seeking short-term pain relief and who have not benefited from other treatments.(24) Pain relief from a glucocorticoid injection seems to last for six weeks and then subsides.(25, 26) One trial suggested that exercise was more effective at reducing pain in knee OA than glucocorticoid injections.(27)

Paracetamol

Paracetamol does not seem to reduce pain in OA and so is not recommended as an initial treatment of knee or hip OA.(20) It also has similar side effects to other anti-inflammatory medications.(28)

Hyaluronic acid injections

Studies about hyaluronic acid injections in knee and hip OA do not show a major benefit.(29, 30) More studies are needed in this area before these injections can be recommended.(5) Large, rigorous trials have failed to demonstrate a relevant benefit of hyaluronic acid injections in OA.(31)

Platelet-rich plasma (PRP)

There is a growing body of evidence supporting PRP over saline (non-medication) and hyaluronic acid injections in OA. PRP is a blood product produced by centrifugation (spinning blood tubes) and removing the red blood cells from the mixture. One trial found that PRP reduces pain and increases function for 12 months in patients with knee OA.(32) PRP provides high concentrations of your body’s natural growth factors to the site of injections, which can increase cell division and cartilage healing in OA-affected joints.(33) PRP also seems to reduce inflammation in the joint.(34) Moreover, very few side effects are reported from PRP treatment.(35)

Opioids

Opioids, such as oxycodone, hydromorphone and tramadol, should only be used in the short term for severe OA symptoms that drastically impact your function.(5, 36) They are not beneficial long term and commonly cause nausea, dizziness and drowsiness.(37) Several studies have shown that opioids reduce pain by a level similar to anti-inflammatories.(38, 39)

Curcumin

There is some evidence that supplements containing curcumin, a component of turmeric, provide symptomatic relief with no side effects.(40)

Boswellia serrata

There is some evidence that Boswellia serrata, also known as Indian frankincense, provides symptomatic relief with no side effects.(40)

Other nutritional supplements

The supplements listed below require more studies to elucidate any benefit in OA. Some also require further research into safety and side effects: (5, 40-43)

• Glucosamine (44-46)

• Chondroitin (47, 48)

• Vitamin D (49)

• Diacerein

• Avocado soybean unsaponifiables

• Fish oil (50)

• Phyto-flavonoids, including flavocoxid (51, 52)

Recommendations

At Surecell, we recommend trying a variety of lifestyle measures to manage your OA. Following adherence to lifestyle changes, patients may benefit from a discussion about medication options.

Support available at Surecell

If you are looking for tailored lifestyle and medication advice, we offer exercise physiology, personal training and gym facilities, as well as medical support. Surecell is a specialist provider of regenerative medicine treatments, including platelet-rich plasma (PRP). Feel free to contact our friendly staff on 03 9822 9996, or simply fill in your contact information here.

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