Osteoarthritis: prescription medications
Much of osteoarthritis treatment and prevention is physical or biomechanical — aimed at reducing stress on joints or improving strength. This is often achieved by losing weight, if you are overweight, and with strength and flexibility exercises. However, pain relief is no less important, and this is where medicines can help.
Paracetamol
Paracetamol is often effective for pain not accompanied by inflammation and is the medication your doctor may try first. Although paracetamol is available without a prescription, it is very effective, particularly if taken on a regular basis rather than when pain occurs. You should not take more than 8 tablets (4 g) per 24 hours without consulting your doctor, as liver damage may occur in amounts greater than this.
Other analgesics
Simple analgesics (painkillers) should be tried before combination analgesics such as paracetamol plus codeine. Osteoarthritis is more common in elderly people than younger people, and it is normally recommended that the elderly avoid products containing codeine as it affects the central nervous system (CNS) and elderly people may be more susceptible to CNS effects such as sedation. In addition, medicines such as codeine can cause constipation.
Tramadol (Tramal) is another painkilling medication that acts in a different way to some other analgesics. It may be helpful in pain not relieved by NSAIDs (non-steroidal anti-inflammatory drugs), however it may also have the side-effect of sedation.
Oral non-steroidal anti-inflammatory drugs (NSAIDs)
If your osteoarthritis pain is not responding to paracetamol, NSAIDs (simply, drugs that help inflammation that are not steroids) may be prescribed, particularly if you have joint inflammation. They are often taken on an ‘as needed’ basis during the occurrence of symptoms. Common NSAIDs used include ibuprofen (e.g. Brufen, Nurofen), naproxen (e.g. Naprosyn), diclofenac (e.g. Voltaren), piroxicam (e.g. Feldene), ketoprofen (e.g. Orudis) and indomethacin (e.g. Indocid).
There doesn't seem to be any important difference between NSAIDs in terms of their effectiveness, so factors such as your age, kidney and liver function and previous experience with NSAIDs will determine which NSAID is most suitable for you. Unfortunately, NSAIDs have the potential to cause gastrointestinal side-effects such as stomach ulcers and bleeding, which limits their use for some people susceptible to stomach problems. They should be used at the lowest possible dose for the shortest possible time.
Topical NSAIDs (which are rubbed into the skin) include Feldene Gel (piroxicam), Nurofen Gel (ibuprofen), Orudis Gel (ketoprofen) and Voltaren Emulgel (diclofenac) and are available over-the-counter from pharmacies.
COX-2 Specific Inhibitors (coxibs)
Coxibs are a relatively new class of medications which appear to be just as effective in relieving pain and inflammation as the older NSAID medications. Celecoxib (brand name Celebrex) is available in Australia. Coxibs are believed to cause fewer gastrointestinal side effects and may be suitable for people who cannot take the older, conventional NSAIDs.
However, coxibs may be associated with an increased risk of cardiovascular events, such as heart attack and stroke, when taken in high doses. People who are at increased risk of heart disease or stroke should not take coxibs. You can discuss the risks and benefits of treatment with coxibs with your doctor, who will be able to tell you whether or not they are suitable for you.
Meloxicam (Mobic)
Meloxicam (brand name Mobic) is another medication for the treatment of osteoarthritis. Meloxicam is variously described as a selective COX-2 inhibitor, a COX-2 selective inhibitor and a non-steroidal anti-inflammatory drug (NSAID) of the enolic acid class. Meloxicam is said to interfere more with the pain and inflammation-producing COX-2 enzyme than with the stomach-protecting COX-1 enzyme which means that a person taking meloxicam may be able to gain relief from pain and inflammation without the same level of stomach problems they may get from taking a conventional NSAID.
In February 2005, the Therapeutic Goods Administration in Australia warned that meloxicam should not be prescribed for people who are at increased risk of cardiovascular events, such as heart attacks and strokes, and that treatment should be limited to the shortest time needed. Your doctor can advise you on whether this medication is suitable for you.
Corticosteroids
Corticosteroids are a type of steroid naturally made by the adrenal glands. They work by suppressing the immune system, acting against inflammation. In osteoarthritis, corticosteroids are injected into the joint. Your doctor will advise whether this is recommended for you.
You may be advised to avoid using the joint too much for 24-48 hours after the injection to ensure the beneficial effects last as long as possible. Frequent injections of corticosteroids may lead to damage to joint structures, so this treatment is usually limited to 2-3 times per year.
Viscosupplementation
Viscosupplementation is a physical process rather than a medication to be taken. To understand what it is, you need to understand something of the functioning of a normal joint.
Hyaluronan (hyaluronic acid) is a natural component of the synovial fluid in a joint and plays a critical role in normal joint functions, such as lubrication and keeping down inflammation. In the joint with osteoarthritis, the hyaluronan is affected and can’t carry out these functions so well.
This has led researchers to develop a method to inject extra hyaluronan into the affected joint. This process is called viscosupplementation.
Hylan (e.g. Synvisc) is a hyaluronan-based product available for the treatment of pain associated with osteoarthritis of the knee. It is given as a course of 3 injections over 3 weeks. Sodium hyaluronate (e.g. Fermathron) is a similar product also available for osteoarthritis of the knee joint. It is given by injection into the affected joint once weekly for no more than 5 weeks. Neither product is currently subsidised so the treatment may be expensive for some people.
Last Reviewed: 30 March 2006
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