Hands: Drug treatments
Drug treatments commonly used in the manifestations of osteoarthritis are listed below.
There is no specific drug treatment for a joint.
However, the information provided in this section can in no way replace a consultation. Only your doctor is able to prescribe a suitable treatment for your condition, which will effectively relieve your pain.
For more information on classes of drug, simply click on each one of them.
Hands: Analgesics
WHAT ARE THEY USED FOR?
The role of analgesics, also simply called painkillers, is to relieve pain.
Those which act on the actual site of the osteoarthritic pain, i.e. the joint, are called peripheral analgesics. Some non-steroidal anti-inflammatory drugs at low doses can also be used for their action against pain.
There are others that affect the way pain is perceived by the brain. These are called central analgesics. The main ones are dextropropoxyphene, codeine and caffeine. They have a superior action to the aforementioned drugs and should be offered only if the peripheral analgesics have failed to relieve pain.
"Strong" central analgesics relate to morphine and its derivatives. They are necessary only exceptionally in osteoarthritis. If a doctor is required to prescribe them, he or she must do so according to very strict rules of use.
HOW DO THEY WORK?
Taking pain relief should be based on the pain:
if the pain is permanent, they should be taken several times at regular intervals throughout the day, usually every 6 hours. In cases of intermittent pain, the time to take them should be based on the onset of pain. Meals do not influence the effectiveness of painkillers; they can be taken at the most appropriate time in relation to the pain.
So, as you can see, you have an important part to play in managing your pain so as to determine exactly when the pain relief will be most useful.
WHAT PRECAUTIONS NEED TO BE TAKEN?
Peripheral analgesics are generally well tolerated, but care must be taken not to exceed the maximum dose recommended by your doctor on the prescription.
Although rare, side-effects can be caused by peripheral analgesics (liver problems, allergies, etc... )
Your doctor is aware of them and will choose the most suitable drug for you. Side-effects are unpredictable. Central analgesics may cause drowsiness, nausea, constipation and dizziness. It is important to know that these unpredictable side-effects usually stop with continued use of the drug. However, these analgesics should be monitored by your doctor. Follow your doctor's prescription to the letter and do not hesitate to ask him or her any questions that you might have.
Do not combine two painkillers yourself as it is usually unnecessary and increases the risk of side-effects.
Hands: NSAIDs
WHAT ARE THEY USED FOR?
Anti-inflammatory drugs are useful for reducing or even blocking the inflammation that occurs in osteoarthritis at the time of flare-ups.
They are very useful in these cases because there is evidence to show that there is a strong risk of cartilage damage during flare-ups. The faster this flare-up is brought under control, the more you limit damage to the joint.
HOW DO THEY WORK?
There are two types: steroidal anti-inflammatory drugs which are derivatives of cortisone and non-steroidal anti-inflammatory drugs or NSAIDs which do not contain any. The former are used in osteoarthritis locally when injected directly into the joint.
There are numerous NSAIDs. Aspirin is one of them when used at a dose greater than 2 grams per day. All NSAIDs can be used in osteoarthritis (except those containing phenylbutazone).
Their use is reserved for treating inflammatory flare-ups of osteoarthritis. They should always be prescribed for a short duration, usually not exceeding 10 days.
There is no NSAID drug that is completely more effective than the others. In fact it is undeniable that there are susceptibilities for each individual which means that a NSAID will be very effective in one person when it will be ineffective in another.
WHAT PRECAUTIONS NEED TO BE TAKEN?
NSAIDs are known to be responsible for digestive disorders and in particular for causing ulcers. It is an undeniable risk, particularly in the elderly and in patients who have already had an ulcer Similarly the use of tobacco or alcohol increases this digestive risk This risk is not related to taking the drug orally, but is the same even if NSAIDs administered in the form of suppositories or intramuscular injections. However it is possible to manage this risk, because medications that protect the stomach may be associated in people at risk Lastly, you need to keep in mind that the risks are offset by the definite efficacy of these drugs. In addition there are new generation NSAIDs: coxibs. Because of their particular action mechanism, these drugs are as effective as classic NSAIDs but have the advantage of being better tolerated by the stomach.
Other side-effects are possible: allergies, impaired kidney function, coagulation disturbances.
Your doctor is aware of the side-effects of NSAIDs and only he or she is able to judge the need for taking NSAIDs.
Never combine two anti-inflammatory drugs at the same time and tell your doctor if you are taking aspirin: this combination is also contraindicated. Do not decide to take an anti-inflammatory drug by yourself without notifying your doctor.
Your doctor may have prescribed an anti-inflammatory ointment or gel for you to apply to a painful joint. This type of treatment is particularly suitable for small joints such as fingers, for example.
They have the advantage of acting quickly and with very little diffusion into the blood. They are particularly interesting for limiting the side-effects that are sometimes caused by anti-inflammatory drugs, especially for people suffering from stomach problems.
