There are a number of different treatment options available for osteoarthritis. However, it is important that medicines and dosage be reviewed every 2 or 3 months because the severity of pain increases and diminishes — it is not usually static for long periods. As with all medicines, it is important not to exceed the recommended dose and to seek further advice if your pain is not relieved.
Regular paracetamol (such as Dymadon, Herron, Panadol or Tylenol) is the first choice of treatment in mild to moderate osteoarthritis. Two tablets (1 g) 3 or 4 times daily is the recommended dosage. It must, however, be taken regularly — not just when required — to have the best effect. Aspirin is not usually recommended in osteoarthritis because of the level of doses required for pain relief and the adverse effects on the stomach.
Simple analgesics should be tried first before combination analgesics such as paracetamol plus codeine (for example, Codral Pain Relief, Dymadon Co. or Panadeine). Because osteoarthritis is more common in elderly people, it is normally recommended that they avoid products containing medicines that affect the central nervous system (CNS), for example, codeine. Elderly people may be more susceptible to CNS effects such as sedation, and medicines such as codeine can cause constipation.
Osteoarthritis is not normally an inflammatory condition, but occasionally the irritation and cartilage repair results in some inflammation. In this situation, NSAIDs such as ibuprofen (for example, Brufen, Nurofen or Tri-Profen) or naproxen (for example, Naprogesic) may provide added benefit.
However, usually NSAIDs are used only after regular paracetamol has been tried first, as they may cause side effects. NSAIDs are not recommended for people with stomach ulcers, indigestion or other stomach problems, and they should be used with caution in people with asthma, elderly people (over 75 years old) and people with serious medical conditions as they may affect kidney function or interact with other medicines.
Topical NSAIDs (such as Difflam Gel, Feldene Gel, Orudis Gel, Nurofen Gel and Voltaren Emulgel) are creams or gels that are usually used for muscular aches and pains, and the evidence for use in osteoarthritis is limited.
Topical anti-inflammatories are absorbed through the skin and into the bloodstream in small amounts, so it is still important to consider the same precautions as for NSAID tablets.
The process of rubbing rubefacients (creams or ointments that produce a reddening effect on the skin) such as Dencorub Arthritis Cream, Finalgon, Metsal and Zostrix on to the skin may help stimulate blood flow and create some warmth, which may contribute to pain relief. Take care to wash your hands afterwards, and avoid getting the product in your eyes or on broken skin — it can sting.
Some clinical studies of glucosamine indicate that 500 mg taken 3 times daily orally may help relieve pain and help preserve cartilage. Glucosamine's effects may take up to 4 weeks to be noticed. However, because glucosamine is also important in glucose metabolism and possible insulin resistance, it should not be taken by people with diabetes without first seeking medical advice. People taking glucosamine should also be monitored by their doctor for signs of glucose intolerance such as increased urination, infections and disturbed vision.
Last Reviewed: 18 February 2003