Current pharmacological treatment of osteoarthritis

In this overview, the currently available symptomatic treatments of osteoarthritis from the published literature are evaluated. Paracetamol attracts growing interest as a less toxic yet potent alternative to NSAIDs. These latter agents are, however, used more widely than paracetamol, although adverse reactions associated with their use are of increasing concern among both patients and physicians. New NSAIDs are still under development. While there is not much evidence of important differences between NSAIDs in overall efficacy, they do vary with regard to toxicity. The cytoprotective effect of misoprostol in at-risk patients on NSAIDs is established but the cost-effectiveness is unclear. Furthermore, percutaneous administration of NSAIDs, capsaicin, and other substances may have some merit. Opioids, such as dextropropoxyphene, are used in combination with paracetamol in patients intolerant to NSAIDs or when pain is not controlled with NSAIDs. Locally administered glucocorticoids may have a disease-modifying effect and are of symptomatic use in certain situations. The role, if any, of hyaluronan therapy remains to be established. Although this agent appears to have a good safety profile, it is expensive. Chondroprotection is an interesting field for future research, although there is no good evidence supporting its existence in clinical medicine as practised now.