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Review of Treatment for Knee Osteoarthritis

Primary care physicians will see many patients with osteoarthritis (OA). In this article, Dr. Stanish, professor of orthopedic surgery and director of a sports medicine clinic in Canada reviews this condition. A special focus is on the use of pharmaceutical agents (drugs) to manage symptoms.

OA affects the cartilage covering and protecting the joints. Age, mechanical stress, and genetics play a role in this disease. Inflammation causes pain and leads to degeneration of the joint. Treatment includes patient education, weight loss, exercise, and drugs.

At first, over-the-counter medications such as Tylenol and nonsteroidal antiinflammatories (NSAIDs) are used. Tylenol is safe, effective, and low in cost. When used properly, it doesn't cause GI upset.

NSAIDs are used for severe pain. There's a greater risk of GI and cardiac problems with NSAID-use. Another drug called COX-2 inhibitors have helped to reduce GI problems. Some patients who use COX-2 inhibitors are at risk for cardiovascular events.

Many patients ask about the use of chondroitin and glucosamine products. Studies so far show a wide range of results. Differences seem to be related to the contents and dosage of these supplements. More study is needed to find out which patients can be helped the most from these products.

When standard drugs don't help, then an opioid analgesic should be considered. There is always a concern about addiction. But for some patients, the effect on pain, function, and sleep makes it worth trying them. With the right dose and an overall management program, most patients do not become addicted.

The authors review other forms of treatment for OA including injections and surgery. New treatments on the horizon are mentioned. Cartilage transplants and gene transfer may help future patients build a new joint surface. Disease-modifying drugs for OA are also being developed.

References: Nathan Urquhart and William D. Stanish, MD. Drugs for Knee Osteoarthritis: What Primary Care Physicians Need to Know. In The Journal of Musculoskeletal Medicine. April 2007. Vol. 24. No. 4. Pp. 178-187.

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