ARTHROSIS - MEDICINES FOR THE TREATMENT OF ARTHROSIS

Causes

In all likelihood, arthrosis depends on a set of predisposing factors (multifactorial etiology), therefore it is not possible to identify a single cause. The risk factors include: haemophilia, advanced age, recurrent joint injuries, hip dislocation , genetic predisposition, obesity / overweight, scoliosis, dangerous sports.

Symptoms

More than by symptoms, osteoarthritis is diagnosed mainly on the basis of radiological and pathological criteria: in the patient suffering from osteoarthritis, damage to the surface of the articular cartilage and bone remodeling are observed. In case of severity, arthritis is characterized by a marked reduction of the joint space. Osteoarthritis causes joint pain, swelling and bone stiffness.

Medicines

Like rheumatoid arthritis, arthrosis cannot be cured definitively either; in any case, the respect of some precautionary rules and the administration of painkillers can alleviate the pain and, above all, avoid the degeneration of the disease.
In general, non-pharmacological therapies, such as weight reduction (essential in an obese person with osteoarthritis) and constant physical exercise, should be encouraged in order to maintain good joint mobility.
As far as pharmacological measures are concerned, paracetamol represents the drug of first choice for pain control; in case of moderate and severe pain, it is possible to combine several drugs (eg paracetamol and ibuprofen). Sometimes, the pain accompanying osteoarthritis is so severe that opioid medication is required.
Hyaluronic acid and chondroprotective drugs are used for osteoarthritis in the infiltrative treatment of the knee: these active ingredients, in addition to delaying the damage to the cartilages, are able to defend the joints, making them less fragile.

The following are the classes of drugs most used in the therapy against osteoarthritis, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Oral anti-inflammatory drugs for pain control:

Paracetamol or acetaminophen (Acetamol, Tachipirina, Sanipirina, Efferalgan, Normaflu): paracetamol is considered the first-line drug for the treatment of pain control associated with "osteoarthritis. The efficacy of this drug is comparable, in this case, to that exerted by acetylsalicylic acid, although - it must be remembered - it does not carry out any anti-inflammatory activity. Tablets formulated with both active ingredients are available: to control pain, take 2 capsules per os (formulated with 250 mg of paracetamol and 250 mg of acetylsalicylic acid) every 6 hours. It is recommended not to exceed 8 capsules per day. In monotherapy, paracetamol is administered at a dose of 0.5-1 gram, every 4-6 hours (not to exceed 4 grams per day) .

Ibuprofen (eg. Brufen, Moment, Subitene): to treat pain associated with osteoarthritis, it is recommended to start therapy with 400-800 mg of the drug, to be taken orally every 6-8 hours. The maintenance dose can be increase to a maximum of 3200 mg, based on patient response.

Naproxen (eg. Aleve, Naprosyn, Prexan, Naprius): indicatively, take 250-500 mg of naproxen or 275-550 mg of naproxen sodium orally, twice a day. For the maintenance dose, the dose can be increased up to 1500 mg of naproxen or 1650 mg of naproxen sodium, divided into two doses, over a period of six months.

Indomethacin (eg. Difmetre, Indom, Liometacen): for the treatment of pain associated with osteoarthritis, it is possible to take the drug in the form of immediate-release tablets (25 mg per os, every 8-12 hours, up to a maximum of 150-200 mg), on a full stomach, immediately after meals. It is possible to combine antacid drugs to buffer the acidity created by the drug (typical side effect). For slow-release tablets, take 75 mg of active, orally, once a day; for the maintenance dose, the dosage can be increased up to 75 mg, twice daily. The drug is also available as suppositories to be taken rectally: in this case, the expected dose is 50 mg, every 8-12 hours.

Nabumetone (eg. Nabuser, Artaxan, Relifex): this anti-inflammatory-pain reliever drug is generally taken orally, at an initial dose of 1 gram per day, before going to bed. The maintenance dose involves taking 1.5-2 grams of the drug per day. Do not exceed 2g / day.

Piroxicam (eg. Feldene, Piroxicam EG, Artroxicam): take 20 mg of the drug orally, once a day; alternatively, take 10 mg of active, twice a day. Do not exceed 20 mg per day.

Glucosamine (eg. Xicil): indicated to treat mild and moderate pain in the knee, in the context of osteoarthritis. Indicatively, take 1.5 grams of active, once a day. In case of lack of efficacy after 2-3 months of therapy, it is possible to change the drug.This drug can also be used for infiltrations in the knee.

Celecoxib (eg. Aleve, Naprosyn, Prexan, Naprius): the drug is a selective inhibitor of cyclooxygenase 2, indicated to treat pain in the context of osteoarthritis when paracetamol is not sufficient to ensure a beneficial effect, and when other NSAIDs they increase the risk of bleeding in the gastrointestinal tract. Take 200 mg once a day, also by dividing the load into two distinct doses.

Drugs with local application / infiltration for pain control in the "field of" osteoarthritis:

Capsaicin (eg Qutenza): for the symptomatic treatment of osteoarthritis it is possible to apply an ointment formulated with capsaicin 0.025% on the skin, for 1-2 weeks, 3-4 times a day, or until the pain subsides. The drug can cause a burning sensation, especially during the first few applications; however, the side effect is generally transient. Avoid contact with eyes and with irritated or broken skin.

Methylprednisolone acetate (eg. Medrol, Urbason, Solu-Medrol): the infiltration of corticosteroids on the knee can benefit the patient with osteoarthritis; however, the therapeutic effect is often transitory, particularly when the disease is associated with an inflammation of the soft tissues. Indicatively, the dosage foresees to inject weekly or monthly from 4 to 120 mg of drug. The dosage and the frequency of the injections must be established by the doctor according to the severity of the arthrosis and the intensity of the pain.

Sodium hyaluronate (eg. Artz injectable): the drug is injected into the joint affected by arthrosis. The analgesic effect varies from 1 to 6 months, depending on the severity of the condition; in the short term, sodium hyaluronate infiltrations can aggravate knee inflammation. The drug is available in 2.5 ml ampoules; injections can be given weekly or monthly, depending on the severity of the osteoarthritis. Consult your doctor.