Health Conditions

The first step in treating osteoarthritis is to utilize non-drug therapies like weight loss to remove pressure on the joints. Exercise and physical therapy are used to strengthen the joints, and patient education is provided to increase cooperation with treatment.

The second step is drug therapy. The first drug doctors generally use is acetaminophen (the medication found in Tylenol). The recommended dose is up to 4000 mg daily. If the patient cannot tolerate or does not respond to acetaminophen, a nonsteroidal anti- inflammatory (NSAID) or a COX-2 inhibitor such as Celebrex (celecoxib) may be used. The American College of Rheumatology recommends that patients avoid opioid analgesics such as propoxyphene, codeine, or oxycodone, except for short-term treatment when pain worsens. Non prescription topical analgesics such as Ben Gay (methylsalicylate, Pfizer) and Zostrix (capsaicin, Medicis) may help relieve minor pain.

Patients with osteoarthritis of the knee may receive short-term relief from pain with conticosteroid injections directly into the affected joints. In 1997, the United States Food and Drug Administration approved two new products that are derived from hyaluronic acid, Hyalgand (sodium hyaluronate, Sanofi) and Synvisc (hyland GF 20, Biomatrix). These agents are injected into the knees of people with OA once a week for three or five weeks.

Hyaluronic acid is naturally produced by the body and lubricates cartilage within the joint. In some patients with osteoarthritis, inflammation breaks down the hyaluronic acid so that lubrication is lost. Hyaluronic acid injections replace or supplement the body's natural hyaluronic acid. Supplemental hyaluronic acid is a purified extract from the combs of roosters. It is a thick substance that is injected into the joint once a week for three or five weeks, depending on the specific brand of product. Mild side effects include local symptoms such as pain, knee swelling, rash and itching at the injection site. Clinical studies show these drugs are as effective as acetaminophen in providing pain relief. However, there is no definite evidence that the treatment alters the progression of osteoarthritis of the knee. There is also no information on the long-term effects of repeated cycles of the injections.

The third step is to consider surgery for patients with severe and painful osteoarthritis that fails to respond to other methods of treatment.

A number of clinical trials have evaluated the use of both glucosamine and chondroitin sulfate (two herbal products) for individuals with osteoarthritis. Because the findings from these studies have been limited, the American College of Rheumatology does not recommend their use at this time. However, a clinical trial supported by the US National Institutes of Health has recently shown that glucosamine and chondroitin sulfate may have a role in the treatment of osteoarthritis in patients with moderate to severe knee pain.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.