Nonsteroidal anti-inflammatory drugs are no longer the treatment of choice for patients with osteoarthritis. New guidelines from the American College of Rheumatology recommend acetaminophen as first-line therapy for knee and hip OA. The guidelines are designed to help control the pain and minimize the disability associated with OA.
The authors write: "Because of concerns about possible deleterious effects of NSAIDs on articular cartilage metabolism, questions about the role of synovial inflammation in the natural progression of OA, and recognition of the greater risk of toxicity from prolonged NSAID therapy in elderly OA patients, the central role of NSAIDs in treating patients with OA has been questioned."
Commonly referred to as "wear and tear" arthritis, OA occurs when cartilage and tissues between joints break down. OA typically affects the knees, hip, fingers, and spine. It can affect a single joint or many joints, causing pain and stiffness, decreased mobility, and, in severe cases, disability.
At a press conference announcing release of the guidelines, Roy Altman, M.D., chief of the arthritis division, University of Miami School of Medicine, explained that an important nonpharmacologic measure for pain relief associated with OA is a balance of rest and exercise. "Exercise is important because it actually protects the joint," he said.
Obesity is a major risk factor for the development of OA of the weight-bearing joints. Weight loss, Altman noted, is extremely important in trying to reduce the symptoms of OA. "You just need a modest amount of weight loss to reduce the pain of OA in the knees," he said.
Other nonpharmacologic measures for the management of OA include: Physical or occupational therapy The use of support devices such as canes or crutches Lifestyle changes for specific problems
Marc C. Hochberg, M.D., M.P.H., head of the division of rheumatology and clinical immunology, University of Maryland School of Medicine, told the audience, "The focus of the use of medications in osteoarthritis is to relieve pain and, by relieving pain, reduce the disability the patients have. Based on our review of the literature, we recommend that the simple analgesic acetaminophen, given in doses of up to 1,000 mg four times a day, be the first-line approach for symptomatic patients with OA of the knee or hip."
Hochberg said that studies comparing acetaminophen with NSAIDs for knee OA found the efficacy of acetaminophen comparable to that of anti-inflammatory doses of NSAIDs. In addition, a survey found, 1,000 practicing rheumatologists consistently recommend acetaminophen over NSAIDs.
Hochberg said acetaminophen was recommended over NSAIDs as first-line therapy for OA because of "concerns about the potential toxicity of prescription NSAIDs in the elderly and the possible harmful effects in terms of cartilage metabolism, since cartilage is the primary tissue affected with OA. …