Drugs Used in Osteoarthritis

Question 1

Acetaminophen

Answer 1

ACETAMINOPHEN

Acetaminophen is generally the first-line treatment for mild to moderate osteoarthritic pain without signs or symptoms of inflammation.

Acetaminophen has no clinically significant anti-inflammatory activity and is less effective than full doses of NSAIDs, but has fewer adverse effects.

Question 2

Diclofenac

Answer 2

NSAIDS

If the clinical response to acetaminophen is not satisfactory, or if the clinical presentation of osteoarthritis is inflammatory, an NSAID should be prescribed.

Full doses of NSAIDs are more effective than full doses of acetaminophen for the treatment of osteoarthritis.

NSAIDs may be used in addition to or in place of acetaminophen.

Diclofenac is available as a topical gel or solution for local treatment of osteoarthritis. Such topical preparations are useful in patients with symptomatic disease limited to a few sites or in patients at increased risk for adverse effects with systemic NSAIDs.

Question 3

Duloxetine

Answer 3

DULOXETINE

The selective serotonin and norepinephrine reuptake inhibitor duloxetine is approved for treatment of chronic musculoskeletal pain.

Question 4

Tramadol

Answer 4

TRAMADOL

Approved for treatment of moderate to moderately severe chronic pain in adults.

Question 5

Hydrocodone, Morphine and Oxycodone

Answer 5

OPIOIDS

Last resort for treatment of intractable osteoarthritis pain. Agents used include hydrocodone, morphine, and oxycodone.

Question 6

Capsaicin

Answer 6

CAPSAICIN

Topical application of capsaicin appears to be effective for some patients in reducing osteoarthritic pain.

Used as an adjunct in patients with inadequate benefit from oral or topical NSAIDs. Also used in patients unable to tolerate oral or topical NSAIDS or with contraindications to the use of NSAIDs.

It can cause severe skin burns and nerve damage at the site of application. The dried residue can cause coughing, sneezing, and eye irritation.

Question 7

Betamethasone and triamcinolone

Answer 7

INTRAARTICULAR CORTICOSTEROIDS

In patients with persistent symptoms in one or a few affected joints, intraarticular glucocorticoid injections can be used. Corticosteroid intra-articular injections can be effective in relieving osteoarthritis pain, even in joints that are not obviously inflamed.

Betamethasone and triamcinolone are the glucocorticoids commonly used.