Pharmacologic and non-drug therapies for osteoarthritis

Many treatments have been shown to relieve symptoms in osteoarthritis but none have been found to influence the course of the disease. In the context of a symposium on cartilage changes in osteoarthritis, the major interest is in the possible action of non-steroidal anti-inflammatory drugs, either favourable or unfavourable, on the progression of cartilage destruction in this disease. On the one hand, there is experimental evidence that some anti-inflammatory drugs like indomethacin can adversely affect cartilage or interfere with repair mechanisms. Others like tiaprofenic acid do not have such effects. There is largely anecdotal evidence that indomethacin therapy can lead to rapid progression of hip disease in osteoarthritis. On the other hand, it is traditionally postulated that the process of inflammation with the release of enzymes and other noxious substances in diseases like rheumatoid arthritis, leads to cartilage damage. Anti-inflammatory drugs might be expected to inhibit such a process as they do in animal models. The long term actions of anti-inflammatory drugs are now being explored in a large scale prospective trial which should provide an answer to the question of whether anti-inflammatory drugs are good or bad for osteoarthritis. Meantime they remain the major symptomatic therapy for the disease.