Drugs of choice [1]
Drug therapy for osteoarthritis is symptom dependent. The use of simple analgesics may be
all that is required for the relief of pain in joints.
acetaminophen 650-975 mg, every 4 h prn $0.14-0.21/day
Second-line therapies
1. As an adjunct to acetaminophen. May also be used with other second-line therapies.
glucosamine [2,3] 500 mg, tid prn $0.50/day
or capsaicin [4] 0.025% cream, qid prn $7.80/42.5 g
2. ASA
or NSAIDs should be tried only when simple analgesics have failed, as they are
generally no more effective than simple analgesics, and they may cause further cartilage
damage. Low-dose NSAIDs can also be combined with acetaminophen.
[5,6]
ASA, enteric-coated 650 mg, qid prn $0.10/day
or ibuprofen 300-400 mg, qid prn $0.11-0.15/day
or naproxen 250-500 mg, bid prn $0.21-0.42/day
or indomethacin 25-50 mg, tid prn $0.29-0.50/day
3. Intra-articular corticosteroids, as an alternative
to NSAIDs particularly in the elderly [7]
methylprednisolone 4-80 mg, intra-articular, every4 months prn
$0.47-9.00/injection
or triamcinolone 5-40 mg, intra-articular, every4 months prn
$1.46-6.82/injection
Additional instructions and notes
-For osteoarthritis of the knee an aerobic or a resistance exercise program produces
modest improvements in measures of disability, physical performance and pain.[9]
-NSAIDs should be avoided in the elderly if possible.
-Reassess NSAIDs after 4-6 weeks of use. If there is no benefit at this time then they
should be discontinued.
-There is a tendency to opt for lower dosage schedules of NSAIDs in treating
osteoarthritis.