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Osteoarthritis (OA) is one of the more prevalent diseases of aging affecting 16 million Americans and over 80% of those over the age of 75 years old. It has commonly been referred to as a "wear and tear" disorder of the joints but it is more accurately described as a non-inflammatory disorder, unlike rheumatoid arthritis, which results in loss of cartilage with resulting changes in the bone structure and eventual pain and disability. Symptoms include deep joint pain, joint stiffness especially in the waking hours, and joint deformities especially of the end-joints in the hands. Joints commonly affected include hands, knees, hips and spine.

What is concerning about OA is that it can be severely disabling, possibly requiring surgery and joint replacement. However, early intervention may improve quality of life by increasing joint mobility and delaying the onset of disability.

In this article we will discuss the non-drug therapies for OA and then review drug therapy for OA in our OA Drug Review.

Non-Drug Therapies

1. weight loss (if indicated due to obesity) since being overweight greatly increases the progression and severity of the disease
2. physical therapy since physical therapy will increase joint functionality and reduce pain
3. appropriate exercise and patient education.

Please, always bear in mind that the non-drug therapies for managing OA are the foundation of successful management. Drug therapies should be used as adjunctive treatments for management of pain and/or inflammation if present. More can be learned about Non-Drug therapies by going to our Ask Terri column.

Osteoarthritis Drug Review

When acetaminophen use is ineffective or toxic low-dose NSAID use is recommended. NSAID stands for non-steroidal anti-inflammatory drug. Commonly used NSAID's are Motrin (ibuprofen), Relafen, Naprosyn, etc. Refer to our article titled NSAID's for more specific information on NSAID's. NSAID's are usually well tolerated and are effective at reducing pain and inflammation if present. However, use of NSAID's is not without risk. Serious adverse effects, such as gastrointestinal ulceration and bleeding, allergic reactions, and adverse effects on the kidneys, are concerning enough to warrant guidance with their use. The most common adverse effect that helps direct which NSAID to use in the elderly is that of GI ulceration. Based on the relative risk of ulceration, AgeNet has developed an OA Drug Review.

Recently, Glucosamine Sulfate and Chondroitin Sulfate have gained a lot of support from the health care community for the management of OA. Eventhough they are listed as "Alternative Agents" in the AgeNet drug review, they can be used in conjunction with other drugs listed below.

Drugs for Managing Osteoarthritis

Preferred NON-NSAID Analgesics	Cost	Manufacturer	Generic	Cost
Tylenol	$$	brand	Acetaminophen	$

Preferred NSAID's	Cost	Manufacturer	Generic	Cost
Celebrex (Celecoxib)	$$$$	brand	no	na
Vioxx (Rofecoxib)	$$$$	brand	no	na

Acceptable NSAID's

Suggested for individuals with low-risk for GI ulceration/bleeding, e.g., 65 years old, no history of GI ulceration/bleeding.

Acceptable NSAID's	Cost	Manufacturer	Generic	Cost
Lodine	$$$	brand	Etodolac	$$
Arthrotec* (Diclofenac/Misoprostol)	$$$	brand	no	na
Relafen (Nabumetone)	$$$$	brand	no	na

*Arthrotec contains a cytoprotectant and is intended to be used by individuals who are at high risk for GI ulceration, e.g. history of GI ulceration/bleeding, over 65 years old, high-dose NSAID use, long term NSAID use, concurrent use of Prednisone, Coumadin, Heparin or low-molecular weight Heparins.

Non-Preferred NSAID's

Non-preferred NSAID's	Cost	Manufacturer	Generic	Cost
Motrin	$$	brand	Ibuprofen	$
Disalcid	$$$	brand	Salsalate	$
Clinoril	$$$	brand	Sulindac	$$
Orudis	$$$	brand	Ketoprofen	$$

Excluded NSAID's

Excluded NSAID's	Cost	Manufacturer	Generic	Cost
Aspirin	$	brand	Aspirin	$
Ansaid	$$$	brand	Flurbiprofen	$$
Feldene	$$$	brand	Piroxicam	$$
Indocin	$$$	brand	Indomethacin	$$
Meclomen	$$$	brand	Meclofenamate	$$
Nalfon	$$$	brand	Fenoprofen	$$
Naprosyn	$$$	brand	Naproxen	$$
Tolectin	$$$	brand	Tolmetin	$$
Voltaren	$$$	brand	Diclofenac	$$
Daypro (Oxaprozin)	$$$	brand	no	na

Alternative Agents

Alternative Agents	Cost	Manufacturer	Generic	Cost
Chondroitin Sulfate	$	brand	Chondroitin Sulfate	$
Glucosamine Sulfate	$	brand	Glucosamine Sulfate	$

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