What medication treatments are available to prevent the progression of osteoarthritis (OA) in the hands and cervical spine (c spine)?

From the Guidelines

Currently, there is no medication that definitively prevents the progression of osteoarthritis (OA) in the hands and cervical spine, and treatment focuses primarily on symptom management rather than disease modification. The most recent and highest quality study, published in 2020 by the American College of Rheumatology (1), provides guidance on the management of osteoarthritis, including recommendations for non-pharmacological and pharmacological treatments.

Non-Pharmacological Treatments

Some key non-pharmacological treatments include:

• Exercise, which is strongly recommended for improving function and reducing pain (1)
• Weight loss in patients with knee and/or hip OA who are overweight or obese (1)
• Self-efficacy and self-management programs (1)
• Tai chi (1)
• Cane use (1)
• Hand orthoses for first carpometacarpal (CMC) joint OA (1)

Pharmacological Treatments

Pharmacological treatments for OA in the hands and cervical spine may include:

• Topical nonsteroidal anti-inflammatory drugs (NSAIDs) for knee OA, which are strongly recommended (1)
• Oral NSAIDs, which are conditionally recommended for symptom relief (1)
• Intraarticular glucocorticoid injections for knee OA, which are strongly recommended (1)
• Acetaminophen, which is conditionally recommended for mild pain (1)
• Chondroitin sulfate, which may provide symptomatic benefit with low toxicity, but has small effect sizes and unclear structure modification benefits (1)

Lifestyle Modifications

Lifestyle modifications, including maintaining a healthy weight, regular low-impact exercise, proper ergonomics, and physical therapy, are essential components of comprehensive OA management (1). These modifications can help improve function and quality of life, even if current pharmacologic interventions cannot reliably halt the progression of OA.

Key Recommendations

• The use of topical NSAIDs is preferred over systemic treatments for mild to moderate pain and when only a few joints are affected (1)
• Oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol (1)
• SYSADOA (e.g., glucosamine, chondroitin sulfate) may give symptomatic benefit with low toxicity, but effect sizes are small and suitable patients are not defined (1)

From the Research

Medication Treatment for Osteoarthritis

• The goal of medication treatment for osteoarthritis is to alleviate symptoms such as pain and loss of function, as there are no disease-modifying treatments available 2.
• Common pharmacologic treatments for osteoarthritis include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids 2, 3, 4.
• Acetaminophen is often recommended as the initial treatment for mild to moderate symptoms of osteoarthritis due to its efficacy and relatively benign side-effect profile compared to NSAIDs 3, 4.
• NSAIDs are associated with a high risk of adverse events, particularly those of the gastrointestinal tract, but may be more effective in patients with more severe disease 3, 4.
• Other treatments, such as antibodies directed against nerve growth factor (NGF-Abs), are under clinical investigation for the treatment of osteoarthritis 2.
• There is ongoing research into the efficacy of various treatments, including hydroxychloroquine, TNF-alpha blockers, and biologic agents that target the nerve growth factor-β, but current evidence does not support their use in osteoarthritis 5.
• Intraarticular administration of platelet-rich plasma is being evaluated as a potential future therapy for osteoarthritis, with beneficial effects observed in knee and hip osteoarthritis 5.

Prevention of Progression

• To date, there is no pharmacologic agent proven to prevent disease progression in osteoarthritis 6.
• Research is ongoing into the potential disease-modifying efficacy of drugs that target bone metabolism, due to the crucial role of the subchondral bone in osteoarthritis pathology 5.
• Strontium ranelate has been shown to delay joint width narrowing in patients with symptomatic knee osteoarthritis, but more research is needed to fully understand its potential as a disease-modifying therapy 5.