Osteoarthritis: prescription medicines
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 medicine your doctor may advise you to try first. Although paracetamol is available without a prescription, it is very effective, particularly if taken on a regular basis rather than just 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 medicine 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.
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 include ibuprofen (e.g. Advil, Brufen, Nurofen), naproxen (e.g. Naprosyn), diclofenac (e.g. Clonac, Voltaren), piroxicam (e.g. Feldene), ketoprofen (e.g. Orudis) and indomethacin (e.g. Indocid).
There doesn't seem to be any major 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 those people susceptible to stomach problems. They should be used at the lowest possible dose for the shortest possible time.
Selective NSAIDs
Selective NSAIDs, also called COX-2 specific inhibitors or coxibs, are a newer class of medicine which appears to be just as effective in relieving pain and inflammation as the older NSAIDs. Celecoxib (brand name Celebrex), etoricoxib (brand name Arcoxia) and meloxicam (Mobic, Movalis) are available in Australia. Coxibs are believed to cause fewer gastrointestinal side effects and may be suitable for some people who cannot take the older, conventional NSAIDs.
However, all NSAIDs, including the newer selective types (coxibs), may increase the risk of heart attack and stroke. This risk appears to be higher in people who are already at high risk of heart attack or stroke (e.g. those with a history of heart attack or stroke, smokers, people who are overweight, those with high cholesterol, high blood pressure, or diabetes). NSAIDS can also increase blood pressure and make heart failure and kidney failure worse.
You can discuss the risks and benefits of treatment with NSAIDs with your doctor, who will be able to tell you whether or not they are suitable for you.
Topical NSAIDs
Topical NSAIDs (which are rubbed into the skin) can help ease pain around joints and include piroxicam (Feldene Gel), ibuprofen (Nurofen Gel), ketoprofen (Orudis Gel) and diclofenac (Voltaren Emulgel, Dencorub Anti-inflammatory Gel). They are available over-the-counter from pharmacies.
Corticosteroid injections
Corticosteroids are a type of steroid naturally made by the adrenal glands. They work by suppressing the immune system, acting against inflammation. In osteoarthritis, synthetic 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.
Hyaluronan injections
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 a joint with osteoarthritis, the hyaluronan is affected and can’t carry out these functions so well. Injecting hyaluronan into a joint to supplement the natural hyaluronic acid may help reduce pain.
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: 09 May 2012
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