Anti-inflammatory medications are available in over-the-counter strength as well as by prescription. The majority of patients with osteoarthritis do not have inflammatory disease, therefore a reasonable medication strategy would be to treat their condition with pain relief medications (analgesics), beginning with Tylenol and nonopiate pain relievers (including prescription medications such as tramadol). Opiates are frequently reserved for severely involved patients who cannot tolerate anti-inflammatories and are close to surgical replacement. Nonsteroidal anti-inflammatory drugs, available over-the-counter or by prescription, carry significant risk for gastrointestinal bleeding and possible injury to the kidneys. These risks are amplified by such illnesses as diabetes, cardiovascular disease and pre-existing gastrointestinal illness. When nonsteroidals are indicated for arthritis yet represent significant treatment risk, the COX-2 selective nonsteroidal Celebrex may provide significant analgesic benefit.
Topical therapies have proven useful in many cases of isolated large weight-bearing joint arthritis. Pepper-based creams including topical Zostrix (applied up to four times a day) are useful adjuncts to oral therapy, weight reduction and exercise. Local injection has also proven beneficial in many cases; lidocaine and short-acting steroid preparations placed into the osteoarthritic joint (knee, hip, shoulder) have demonstrated benefit for patients who may not tolerate oral analgesic therapy. A new class of joint injection consisting of hyaluronic acid preparations has become available over the past several years, and injections are given in weekly intervals (up to five times) with benefit for many patients with osteoarthritis.
Finally, joint replacement arthroplasty is a proven modality for surgical correction of the cartilage deficient joint. In patients with end-stage osteoarthritis, for whom oral medication, topical therapy and local injection holds little potential benefit, joint replacement confers definitive relief of chronic joint pain. Selection of patients and timing of the procedure are critical components in the decision-making process for patients with large weight-bearing joint disease. The average longevity of the replacement knee (as one example) is 15 years. It is preferable to remove an affected joint one time only, as replacement arthroplasty can be technically difficult and materials science has yet to catch up with our increased life expectancy.