preface
Osteoarthritis (OA) is a common chronic pain disease, which is a degenerative disease of joint function damage and osteosclerosis caused by joint cartilage degeneration, which can cause joint pain, deformity, dysfunction, and loss of mobility, and significantly increase the risk of deep vein thromboembolism, cardiovascular events, and hip fractures of the lower limbs. OA can be mainly divided into hip joint, shoulder joint, knee joint, ankle joint, interphalangeal (toe) arthritis, etc., which can be staged into primary stage (pre-stage), stage 1 (early), stage 2 (mild), stage 3 (moderate), stage 4 (severe), and its risk factors include aging, obesity or overweight, female sex, history of joint trauma, joint injury, etc.
OA drug therapy relieves pain, maintains or improves joint function, and protects joint structure.
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Medications for osteoarthritis
There are three main categories of drugs, namely topical drugs, systemic drugs, and injectable treatment drugs.
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Topical medications
Topical patches are recommended for acute pain in OA and mild chronic joint pain. Moderate or severe pain in OA can be used to add other treatments.
Topical nonsteroidal anti-inflammatory drugs (NSAIDs)
For example, loxoprofen sodium gel patch, ketoprofen gel patch, flurbiprofen ester gel patch, etc., can be analgesic and anti-inflammatory, anti-rheumatism, antipyretic, swelling, etc., and can be used for various types of OA in the early stage. Its gastrointestinal reactions and cardiovascular adverse events are very low, and the efficacy is comparable to that of oral NSAIDs.
Precautions: Visible skin reactions such as redness, itching, rash, macules, etc. It is contraindicated in patients with local wounds on the skin and local infections on the skin.
Topical capsaicin
It can be analgesic and used for all kinds of OA, but its effect is poor, and the tissue penetration and anti-inflammatory effect are poor.
Precautions: Local skin reactions such as burning, stinging, redness, rash, etc. can be seen. Do not use on areas of skin lesions.
Preparations of proprietary Chinese medicines for external use
For example, Gutong paste (can dispel wind and cold, invigorate blood circulation, reduce swelling and relieve pain), Tongluo Gujianning ointment (can dispel wind and dampness, promote blood circulation and eliminate blood stasis), can be used for all kinds of OA in the early and middle stages.
Precautions: Local skin reactions such as itching, rash, etc. may be seen. Do not use on broken skin or wounds.
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Systemic acting drugs
Such as oral preparations (most commonly used), injections, suppositories, etc., such as acetaminophen, NSAIDs, anti-anxiety and depressant drugs, joint cartilage protectors, etc.
paracetamol
It can be antipyretic and analgesic, and its damage to the gastric mucosa is small, and it can be used for various types of OA in the early and middle stages, and has a better effect on small joints such as fingers, wrist joints, and toe joints.
Precautions: Rash, urticaria, drug fever, neutropenia, liver damage (short-term overdose, long-term use for more than 6 months), kidney damage (long-term use for more than 6 months), severe skin reactions, etc. It is contraindicated in patients with acute or chronic hepatic dysfunction, decompensated active liver disease, active peptic ulcer, gastrointestinal bleeding, severe hepatic and renal insufficiency, bronchial asthma, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.
NSAIDs
Such as ibuprofen, tromethamine, diclofenac, indomethacin, naproxen, celecoxib, etc., can be anti-inflammatory, analgesic, antipyretic, anti-rheumatism, swelling, can be used for all kinds of OA in the early and middle stages, and is more commonly used for large joints such as knees, shoulders, and hips.
Precautions: Gastrointestinal reactions, peptic ulcers/bleeding, liver and kidney damage, cardiovascular adverse events, increased risk of myocardial infarction/stroke can be seen. It is contraindicated in patients with recent gastrointestinal bleeding, severe heart failure, active peptic ulcer/bleeding, recent coronary artery bypass grafting, and severe renal impairment.
Opioids or combination preparations
For example, morphine, oxycodone, and profen codeine can be analgesic and can be used for various types of OA where NSAIDs are contraindicated or ineffective, or severe pain. Compound opioids are recommended.
Precautions: Constipation, nausea and vomiting, headache, dizziness, drowsiness, dysuria, palpitations, thrombosis, itching, respiratory depression, fractures, addiction, etc. It is contraindicated in patients with undiagnosed acute abdomen, severe respiratory depression, gastrointestinal obstruction, severe brain injury, upper airway obstruction, intracranial mass lesions with intracranial hypertension, and asthma.
Antidepressant anxiety medications
For example, serotonin/norepinephrine reuptake inhibition (SNRIs) duloxetine, venlafaxine, and milnacipran can be used for antidepressant anxiety, analgesia, sleep improvement, and neuropathic pain, and can be used for various OAs accompanied by anxiety and depression.
It is recommended to start at a low dose and gradually increase and decrease the dose.
Precautions: drowsiness, dizziness, nausea, diarrhea, fatigue, dry mouth, constipation, excessive sweating, headache, tremor, etc. Duloxetine is contraindicated in patients who are taking monoamine oxidase inhibitors and have untreated angle-closure glaucoma. Venlafaxine and milnacipran are contraindicated in patients who are using monoamine oxidase inhibitors.
Articular cartilage protectors
For example, diacerein, glucosamine, chondroitin, can be analgesic, improve joint function, protect articular cartilage, delay the progression of the disease, etc., can be used for a variety of OA, mainly knee joints, for the treatment of early and mid-stage OA.
Precautions: Diacerein can be used for intestinal obstruction, inflammatory bowel disease, unexplained abdominal pain, etc., due to diarrhea, frequent bowel movements, abdominal pain, soft stools, elevated liver enzymes, flatulence, itching, rash, gastric bleeding, etc. Glucosamine can cause gastrointestinal symptoms, headache, mild drowsiness, drowsiness, allergic reactions, visual disturbances, asthma, hair loss, and elevated blood sugar. Chondroitin can cause nausea, chest tightness, and a small amount of bleeding from the gums.
New anti-inflammatory drugs
For example, Kampo hexanexin, which can be analgesic, anti-rheumatism, etc., can be used for various OA, mainly in the knee joint, and its combination with NSAIDs can be better in the treatment of OA.
Precautions: Mild drowsiness, nausea, fatigue, epigastric discomfort, facial pigmentation, etc. may be seen.
改善病情抗风湿药物（DMARDs）
For example, alamod can be anti-inflammatory, inhibiting immunity, and protecting bones, and is recommended for the treatment of moderate to severe or inflammatory knee osteoarthritis (KOA), which can improve joint function, significantly relieve joint pain, and reduce the level of inflammatory factors, especially for patients with elevated inflammatory indicators.
Precautions: gastrointestinal reactions, elevated aminotransferases, headache, dizziness, lower limb edema, palpitations, insomnia, chest tightness, bleeding gums, drowsiness, excessive sweating, and decreased white blood cells. It is contraindicated in patients with peptic ulcer disease or a history of peptic ulcer disease and severe liver disease.
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Injectable therapeutic drugs
Such as glucocorticoids, sodium hyaluronate, etc.
Glucocorticoids
It can be strong anti-inflammatory, immunosuppressive, analgesic, etc., with rapid onset, can protect articular cartilage, reduce vascular permeability, control cartilage catabolism, and significantly relieve pain in a short period of time (2 weeks).
It is recommended that the number of injections should not exceed 2-3 times per year, and the interval between injections should not be less than 3-6 months.
Precautions: There is a potential risk of arthritic lesions. It is contraindicated in patients with infectious arthritis, active peptic ulcer disease, systemic infection near the injection site, recent gastrointestinal anastomosis surgery, abnormal coagulation function, or patients with or present severe mental illness.
Sodium hyaluronate
It has good viscoelasticity and profiling, which can relieve pain, reduce the friction between bones and joints, improve joint function, effectively reduce the pressure on joint soft tissues, reduce the dose of analgesic drugs, effectively repair wounds and prevent infections, and the effect can last for several weeks, which is effective for patients with early and mid-stage knee joint OA.
Knee injections are recommended 1 time per week for a total of 4-5 injections.
Precautions: Mild to moderate pain, joint effusion, swelling, etc. can be seen at the injection site. It is contraindicated in patients with local puncture and intra-articular infection.
Platelet-rich plasma (PRP)
It can recruit cartilage-derived cells to stimulate cartilage proliferation, promote cartilage matrix synthesis, inhibit local bursa and other soft tissue inflammation of degenerative cartilage, regulate the level of OA inflammatory factors, relieve pain, regulate the local environment of knee joints, improve knee joint function, promote stem cell proliferation, delay the disease, and is more suitable for young patients with symptomatic OA with degenerative manifestations.
Precautions: Local pain, redness and swelling, intra-articular infection, etc. in the injection area can be seen. It is contraindicated for patients with skin diseases, skin ulcers, sepsis, and abnormal coagulation around the injection area.
Mesenchymal stem cells (MSCs)
It can synthesize/release metabolic cytokines, inhibit inflammation, directly differentiate into specific connective tissues, regulate immunity, promote articular cartilage growth, promote tissue repair, improve pain and function, and is suitable for mild to moderate knee OA.
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Selection of anti-osteoarthritis drugs