Osteoarthritis

Describes mainly regarding the treatment

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PRESENTED BY:
CHALLA.ANITHA , Pharm-D student
Vignan Pharmacy College, Vadlamudi, Guntur

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3. DESIRED OUTCOMES & GOALS OF TREATMENT:
Management of the patient with OA begins with a diagnosis based on a careful
history, physical examination, radiographic findings, and an assessment of the
extent of joint involvement.

GENERAL APPROACH TO TREATMENT:
Treatment for each OA patient depends on the distribution and severity of joint
involvement, comorbid disease states, concomitant medications, and allergies.
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GOALS
To educate the
patient,
caregivers,
and relatives
To maintain
or improve
joint mobility
To limit
functional
impairment
To relieve
pain and
stiffness
To maintain
or improve
quality
of life

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TREATMENT
Non pharmacological
treatment / non drug
therapy.
Pharmacological / drug
therapy.
Surgery
•Arthroscopic
lavage.
•Cartilage repair.
•Osteotomy.
•Arthroplasty.
•Diet
•Physical &
occupational
therapy.
•Surgery.
•Oral analgesics
•Topical analgesics
•Nutritional
supplement.
•NSAIDS
•Hyalouronic acid
products.

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Symptomatic pain acetaminophen topical therapy
Symptomatic pain & inflammation NSAIDS (or) COX-2
Risk for GI
Ulceration
& bleeding
CV risk or risk
for GI events
Chronic kidney
disease
sub therapeutic
response to NSAIDS
or celecoxib





Celecoxib + PPI
(or) misoprostol
Non selective
+ PPI (or)
Misoprostol
(or) tramadol
Tramadol (or)
Intra articular
injections
Naproxen +
PPI (or)
misoprostol
Tramadol

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MEDICATION BRAND NAME DOSE &
FREQUENCY
ORAL ANALGESICS
Acetaminophen TYLENOL 350-650 mg every 4-6 hours
(or) 1g 3-4 times/day.
Tramadol COMBITRAM,
ANATRAM
50-100 every 4-6 hours.
TOPICAL ANALGESICS
Capsaicin 0.025% (or)
0.075%
CAPZASIN, ZOSTRIX Apply to affected joint 3-4
times per day.
NUTRITIONAL
SUPPLEMENTS
Glucosamino sulfate GENICIN 500 mg 3 times/ day (or)
1500 mg once daily

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MEDICATION BRAND NAME DOSE &
FREQUENCY
NSAID’S
1.)CARBOXYLIC ACIDS
a.)Acetylated salicylates
Aspirin (plain buffered (or)
enteric coated
BAYER 325-650 mg every 4-6 hours
for pain, anti inflammatory
doses start at 3600mg/day in
divided doses.
b.)Non acetylated salicylates
Salsalate DISALCID 500-1000mg 2-3 times a day
Choline magnesium
salicylate
TRILISATE 500-1000mg 2-3 times a day

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MEDICATION BRAND NAME DOSE & FREQUENCY
2.)ACETIC ACIDS
Diclofenac VOLTAREN 100-150 mg/day in divided
doses
Indomethacin INDOCIN 25 mg 2-3 times a day, 75
mg sustained release once
daily
Ketorolac TORADOL 10 mg every 4-6 hours
Nabumetone RELAFEN 500-1000 mg 1-2 times a
day
3.)PROPIONIC ACID
Ibuprofen ADVIL 1200-3200 mg/day in 3-4
divided doses
Ketoprofen ACTRON 150-300 mg/day in 3-4
divided doses
Naproxen ALEVE, MIDOL 250-500 mg twice a day

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MEDICATION BRAND NAME DOSE &
FREQUENCY
4.) FENAMATES
Meclofenamate MECLOMEN 200-400 mg/day in 3-4
divided doses
5.) OXICAMS
Piroxicam FELDENE 10-20 mg daily
Meloxicam MOBIC 7.5 mg daily
6.) COXIBS
Celecoxib CELEBREX 100 mg twice daily (or)
200 mg daily.
Valdecoxib BEXTRA 10 mg daily

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DRUGS ADVERSE DRUG REACTIONS
Acetaminophen Hepatotoxicity-increased in patients with
excessive alcohol intake(>3 drinks per day)
Non selective cox-1,2 inhibitors. GI:
Epigastric distress,nausea & vomiting
Gastric & duodenal ulceration
GIT perforation & bleeding
Selective cox-2 inhibitors Increase of cardiovascular event (thrombosis)
Opioid analgesics Nausea, somnolence, constipation &
dizziness
Tramadol Dizziness, vertigo, nausea, vomiting,
constipation & lethargy.

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DRUGS ADVERSE DRUG REACTIONS
Glucosamine & Chondroitin Glucosamine: mild GIT symptoms like
bloating & cramps.
Chondroitin: Nausea
Corticosteroids Flushing, acute inflammatory reaction after
injection atrophy of subcutaneous tissues &
local skin depigmentation may occur
Hyaluronic acid Local reactions, post injection flares &
anaphylaxis (rare)
Capsaicin Burning, stinging, and/or erythema

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14. PROPHYLAXIS OF OSTEOARTHRITIS:
By age 65, more than half of us will have x-ray evidence of osteoarthritis.
Here are 4 steps you can take now to prevent osteoarthritis or its
progression.
1)CONTROL WEIGHT.
2)EXERCISE.
3)AVOID INJURIES OR GET THEM TREATED.
4)EAT RIGHT.
Omega-3 fatty acids.
Vitamin-C.
Vitamin-D.
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CONTROL WEIGHT:
•NHANES ( National Health & Nutrition Examination Survey) studies showed
that obese women were nearly 4 times more likely to have osteoarthritis compared
to non-obese women.The risk for obese men was nearly 5 times greater than for
non-obese men.
•In study of osteoarthritis in a population in Framingham, mass researches
estimated that overweight women who lost 11 pounds or about 2 BMI points
decreased their risk of osteoarthritis by more than 50%.
EXERCISE:
•The safest exercises are those that place the least body weight on the joints , such
as bicycling, swimming & other water exercise.Light weight lifting is another
potion.
AVOID INJURIES OR GET THEM TREATED:
•Suffering with a joint injury when you are young predisposes you to
osteoarthritis in the same joint when you are older.

16. People who injured their knee as an adult had a 5 times greater risk of
osteoarthritis in the joint.
EAT RIGHT:
Although no specific diet has been shown to prevent osteoarthritis, certain
nutrients have been associated with a reduced risk of the disease or its
severity. They include:
Omega-3 fatty acids: These healthy fats reduce joint inflammation.Good
sources of omega-3 fatty acids include:
Fish oils & certain plant/nut oils, including walnut, canola, soyabean,
flaxseed/linseed & olive.
Vitamin-C: Intake of vitamin-C (120-200 mg/day) reduced the risk of
osteoarthritis progression threefold.

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17. You can get more vit.C in your diet by eating green pepper, citrus fruits &
juices, white strawberries, tomatoes, broccoli, turnip greens & other leafy
greens, sweet & potatoes & cantaloupe.
Vitamin-D: Framingham study participants showed that people who have
knee osteoarthritis & low blood levels of vitamin-D are 3 times more likely to
experience disease progression, compared to people with high levels of the
vitamin.
Your body makes most of the vit.D it needs in response to sunlight.
You can get more vit.D in your diet by eating fatty fish such as salmon,
mackerel, tuna, sardines & herring, vit-D fortified milk & cereal & eggs.
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REFERENCES:
RODGER WALKER, CATE WHITTLESEA; Treatment & prophylaxis of
osteoarthritis; Clinical pharmacy & Therapeutics; 5
th
Edition; p.g.no: 843-845
ERIC. T. HERFINDAL, DICK R. GOURLEY, HART; Treatment &
prophylaxis of osteoarthritis; Clinical pharmacy & Therapeutics; 4
th
Edition;
p.g.no: 727-738
BRAIN K. ALLDREDGE, ROBIN L. CORELLI, MICHAEL E. ERNST;
Treatment & prophylaxis of osteoarthritis; Koda – kimble & Young’s applied
therapeutics, The clinical use of Drugs, 10
th
Edition, p.g.no: 990-1000
JOSEPH T. DIPIRO et.al; Treatment & prophylaxis of osteoarthritis;
Pharmacotherapy A Pathophysiologic approach; 6
th
edition; p.g.no: 1685-1700

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