From the Guidelines
The most effective treatment for relief of degenerative osteoarthritis involves a multimodal approach combining medications, physical therapy, and lifestyle modifications, with a focus on aerobic, aquatic, and/or resistance exercises, weight loss, and the use of oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) as recommended by the 2019 American College of Rheumatology guideline 1.
Key Components of Treatment
- Medications:
- Acetaminophen (325-650mg every 4-6 hours, not exceeding 3000mg daily) as the first line of treatment
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) for insufficient relief
- Topical NSAIDs such as diclofenac gel (1% applied to affected joints 4 times daily) for localized relief
- Physical Therapy:
- Strengthening muscles around affected joints
- Maintaining range of motion
- Ideally 2-3 sessions weekly for 6-8 weeks
- Lifestyle Modifications:
- Weight loss of even 5-10% to reduce joint stress if overweight
- Low-impact exercise like swimming or cycling for 30 minutes daily to maintain joint function
- Heat and cold therapy for temporary relief
- Assistive devices like braces or walking aids to improve mobility
Considerations
- The treatment should be tailored according to knee risk factors (obesity, adverse mechanical factors, physical activity), general risk factors (age, comorbidity, polypharmacy), level of pain intensity and disability, sign of inflammation, and location and degree of structural damage 1.
- Opioid analgesics may be considered for moderate to severe pain, but their use should be cautious due to the risk of addiction 1.
- SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) may have symptomatic effects and modify structure, but their use should be based on individual patient needs and responses 1.
- Intra-articular injection of long-acting corticosteroid may be indicated for flare of knee pain, especially if accompanied by effusion 1.
- Joint replacement should be considered in patients with radiographic evidence of knee OA who have refractory pain and disability 1.
From the FDA Drug Label
In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease The most effective treatment for relief of degenerative Osteoarthritis is Naproxen, as it has been shown to reduce joint pain or tenderness, increase range of motion, and improve mobility.
- Key benefits of Naproxen include:
- Reduction in joint pain or tenderness
- Increase in range of motion in knee joints
- Increased mobility
- Improvement in capacity to perform activities of daily living 2
From the Research
Treatment Options for Degenerative Osteoarthritis
The primary goals of current osteoarthritis (OA) therapy are centered on controlling pain, improving or preserving joint function and mobility, and improving health-related quality of life 3.
Non-Pharmacological Treatment
Non-pharmacological therapy, including patient education and physical/occupational therapy, is a primary component of OA management, either rendered alone or in combination with pharmacological treatment 3.
Pharmacological Treatment
Pharmacological treatment options for OA include:
- Acetaminophen, which is considered first-line therapy for mild-to-moderate pain 4
- Nonsteroidal anti-inflammatory drugs (NSAIDs), which are typically more effective than acetaminophen but have adverse effects associated with long-term use 4
- COX-2 specific inhibitors 3
- Topical NSAIDs, which can be recommended for patients with mild OA 5
- Topical capsaicin, which can be used when other treatments are ineffective or contraindicated 5
- Oral NSAIDs, which are suggested at the lowest effective dose for the shortest possible duration to control symptoms in patients with moderate to severe OA 5
- Duloxetine, which can be considered in patients with multiple-joint OA and high risk of NSAID-induced adverse events 5
- Intraarticular injections with glucocorticoids, which can be suggested to achieve short-term pain relief in patients suffering from severe OA-related pain 5
Future Treatment Modalities
Future treatment modalities for OA are geared toward reversing the disease process and may include:
- Disease-modifying drugs 3
- Gene therapy 3
- Biologic agents that target the nerve growth factor-β 6
- Drugs that target bone metabolism, such as strontium renelate, which has been shown to delay joint width narrowing in patients with symptomatic knee OA 6
- Intraarticular administration of platelet-rich plasma, which has been tried in knee and hip OA with beneficial effect 6
Limitations of Current Treatment Options
The efficacy of pharmacological therapies in OA-related pain is often inconsistent, and severe adverse events might occur 5. Therefore, critical use of the different treatment options, considering patient-related comorbidities and nonpharmacological therapies, is of major importance 5.