Medications for Osteoarthritis:

1. Relieving the Pain Medications for Osteoarthritis: Developed by: Eugene B Smith Jr, PharmD , MPH, Associate Professor Laura Jones, MPH, Extension Assistant Bobbi Clarke, PhD, RD, Professor and Extension Health Specialist UT Center for Community Health Literacy

2. What is Osteoarthritis? • Osteoarthritis (OA) is the most common form of arthritis • It is the progressive loss of cartilage in the joints • OA is also known as “degenerative joint disease” • Over 60% of people over 65 have some form of arthritis

3. Osteoarthritis Pain • The motivation for most OA therapy is pain improvement/relief • This cycle represents common problems that can make pain worse • You can break the cycle at any point with a variety of self-help strategies • Pain does not have to control your life The Cycle of Pain Disease Fatigue Tense Muscles Depression Stress/Anxiety Difficult Emotions

4. Breaking the Pain Cycle The Arthritis Self-Help Program is designed to present practical ways that you can break the arthritis pain cycle and regain control of your pain, such as: • Exercise • Adequate rest • Healthy diet/weight loss • Relaxation Techniques • Positive Self Talk • Mental techniques to fight pain • Physical Therapy • Drug therapy • Surgery

5. Exercise and Weight Loss • Exercise: • One of the most effective ways to help arthritis! • Helps reduce stiffness, increases flexibility and prevents falls • Weight Loss: • Research studies have shown that even a 10% loss of weight can improve OA symptoms by 50%!!

6. Drug Therapy • Medications are an important strategy for breaking the pain cycle • Keep in mind- unfortunately, we do not have any drugs that reverse the progression of OA • The main goal of drug therapy: • To relieve pain and help patients exercise and keep the joints functioning

7. Drugs used for OA • Acetaminophen • Topical pain relievers • Non Steroidal Anti-inflammatory Drugs (NSAIDs) • Corticosteroids • Hyaluronic acid • Narcotic pain relievers

8. Acetaminophen • Acetaminophen (Tylenol) is available OTC and has been the best drug for treating the pain of OA for a long time • Be careful to use the right dose: • Read the dosage on the package carefully • Start with small doses even as little as one 500mg dose can be effective • Do not exceed 4000 mg in any daily dosage.

9. Use Caution… • Sometimes people develop a tolerance to pain relievers and need a higher dose to relieve the pain • Doses over 4000 mg/day of Acetaminophen damage the liver and can cause death! • Many drugs contain Acetaminophen. Be sure to read labels and know how much you are getting in a day from all your medications

10. Topical Treatments • There are a variety of things that can be applied to the affected joint that will relieve pain: • Heat and ice • Lidocaine patches • Topical NSAIDS (not for long-term relief) • Capsaicin (Zostrix) • A skin cream made from hot peppers that relieves pain and possibly reduces inflammation over time

11. The Clock is Ticking… Studies show that Topical NSAIDs used in OA are only effective during the first 2 weeks of therapy!!

12. Glucosamine & Chondroitin Are they effective when taken together?? • Many patients claim they help • Some studies have shown slowed progression of joint disease • However, other studies have shown only limited effectiveness in treating pain

13. Glucosamine • In the US, Glucosamine is considered a dietary supplement (not a drug) and does not have to be proven to be effective to be sold • Worstpills.org (a Consumer Reports website) advises consumers to avoid glucosamine due to lack of proven effectiveness

14. What if I decide to give it a try? • Buy a supplement that contains glucosamine only- it will be cheaper and no studies have shown chondroitin to be effective by itself • You should try it for a minimum of 8 weeks and keep a diary to see if you are feeling better • Buy a tested brand: • See www.consumerlab.com for comparisons

15. NSAIDS • “NSAID” stands for: Non-Steroidal Anti-Inflammatory Drug(s) • Different classes of NSAIDS: • Non-selective NSAIDS: • Ibuprofen (OTC) • Naproxen (OTC) • Indomethacin (Must be prescribed) • Selective “COX-2” inhibitors: • Celebrex , Vioxx, and Bextra

16. Are NSAIDs Safe? • In general, NSAIDS are good class of drugs because they treat pain and reduce inflammation • Negative side effects: • Non-selective NSAIDS • Stomach upset/bleeding/ulcers • Selective “COX-2” drugs: • Possibly increase heart attack/disease risk

17. FDA Verdict on Cox-2 Drugs • In 2005, the FDA recommended that warnings appear on the labels of Selective Cox-2 inhibitors concerning their heart risks and requiring each prescription to have a guide describing the risks • They recommended that non-selective NSAIDS carry the same warnings • Fate of Cox-2 Inhibitors: • Vioxx and Bextra were taken off the market • Only Celebrex remains

18. Corticosteroids • These drugs are naturally occurring substances in the body but as drugs they have been further refined to make them more effective. Examples: • Prednisone , Hydrocortisone, Betamethasone, Methylprednisiolone, Triamcinolone,etc • They can be used orally or by injection for OA. They have significant side effects so they should used sparingly (intra-articular injection every 3-6 months)

19. Hyaluronic acid This agent is used by injection into the joints in patients with severe disease and has many advantages but must also be used sparingly. It is used to replace lost fluid in the joint spaces and keep the joint working to cushion the bones in the joint.

20. Narcotic pain relievers • These drugs are reserved for moderate to severe pain after the other options have not worked. Why?: • They make you sleepy and this reduces the ability to drive, work, or exercise • Side effects include: anxiety, constipation, nausea and vomiting, & urinary retention • Tolerance develops soon and treating OA is a lifetime process

21. Conclusion The use of drugs for OA is a proven treatment approach. Recent news releases have reminded us that drugs in these classes have significant side effects that we must be concerned about when we use these drugs. Take care to use drugs wisely!