11 Group of Medicines for Osteoarthritis

By: Maged Taman

Most of these medicines of osteoarthritis can be add on:

1- Oral Tylenol 500 mg every 4-6 hour for pain or in patients who forget to take the pain medicine or with dementia can be give as 500 mg with meals three times a day and at bed time.

2- Oral Antioxidants as vitamin C 500 mg twice a day and fish oil 1000 milligram twice a day (to avoid in patients with fish allergy).

3- Oral joint supporters: that potentially delay the arthritis is hoped for though no firm proof, many patients found it helpful however the nature of arthritis is periods of acting up and periods of no pain make it difficult to be certain. However many clinicians observed pain improvement in a lot of patients. Hyalluronic acid 100 mg twice a day helps to build the liquid in joint (synovia), there is no proof it is absorbed in humans however patients reports relief of pain. Glucosamine 1500 mg daily is another supplement. It is derived from shellfish so have to avoid in people with shellfish allergy. Chondritin is derived from cow cartilage is given as 1200 mg a day. Glucosamine and chondritin possibly help to maintain the cartilages but not well proven. Methylsulfonylmethane (MSM): 2000-6000 mg daily and S-adenosylmethionine (SAMe) 600 mg - 1200 mg daily. All the above supplements are given in divided dose and commonly with 2-3 are combined in same tablet. There is a liquid form as well.

4- Topical anti-inflammatory creams: bengey, voltaren .....

5- Topical capsaicin applied to joints: according to wikipedia: Capsaicin is currently used in topical ointments to relieve the pain of peripheral neuropathy such as post-herpetic neuralgia caused by shingles. It may be used in concentrations of between 0.025% and 0.075%. It may be used as a cream for the temporary relief of minor aches and pains of muscles and joints associated with arthritis, simple backache, strains and sprains. The treatment typically involves the application of a topical anesthetic until the area is numb. Then the capsaicin is applied by a therapist wearing rubber gloves and a face mask. The capsaicin remains on the skin until the patient starts to feel the "heat", at which point it is promptly removed. Capsaicin is also available in large bandages that can be applied to the back.

6- Topical lidoderm patch 5% one to three patches to painful joints from 8 in AM to 8 in PM, to take patch off if heat is applied. It is expensive so can be used if other medications do no work.

7-Oral Anti-inflammatory medications (NSAIDs. and Cox2 inhibitors): can be add on for Tylenol as Motrin 800 mg once daily as needed (there is a lot of inflammatory medications by prescription, ibuprofen and naproxen are over the counter). Thus keep the Motrin for the more strong pain while Tylenol for the milder pain to cut in NSAID's side effects in the stomach. COX2 inhibitors like Meloxicam 7-5 to 15 mg daily as needed is other choice, to use it only occasional. Patients who would request to have NSAID's or COX2 inhibitors in regular basis have to under the risks for ulcers and debatable role in heart disease. Proton pump inhibitors or H2 receptors blockers can reduce ulcers, particularly the proton pump inhibitors.

8- Strong analgesics: tramadol 25- 50 mg three times a day try first at night to see tolerance is an effective less sedating medications. Low dose narcotics have been used successfully in elderly 1/2 tab of vicodin at night many times can control pain at lower risk of confusion and can be safer to the elderly than anti-inflammatory medications.

9- Muscle relaxants particularly if joint pain is associated with spasm to the muscle around commonly occur in back arthritis, flexeril 5 mg at night daily as needed is an example. Avoid combining strong analgesics with muscle relaxants particularly in the elderly.

10- Steroid joint injections can carry patient for few months effect can be dramatic in few hours however pain return in few months repeat injections usually fail over time.

11- Hyallurnic acid joint injection usually effective (mostly the knees) for few months used as last resort before surgery.

It is important to tailor medications to every patient. Some find relief with some medications and not others and tolerance to medications and side effects are variable for patients. Drug prescriptions require knowing side effects, timing, drug interactions and contraindications.

Vitamin D deficiency should also be looked for and corrected, its role to prevent osteoarthritis is being studied.

Local heat as warm packs particularly to back arthritis. (note heat and ice work could be effective as medicine, ice is particularly used in musculoskeletal conditions associated with acute injuries and surgeries). Some found applying heat before execrise and ice after exercise help to releive the pain. Assisting devices like a cane or a walker may provide relief more than medications and help to keep balance and prevent falls. Exercise between bouts of pain is helpful. Physical activity is particularly helpful for the back and big joints. Message also provide relief. Losing weight is quite helpful but less achievable.

A lot of patients can live reasonably well with their arthritis, some will ultimately fail conservative therapy and the joint almost becomes bone on bone with no cushions (cartilage). Joint replacement (commonly to the knees or the hips) is the way go for these cases of advanced osteoarthritis when pain and poor quality of life necessitate the surgery which in most part is very successful.