Therapeutic target
- Relief of symptoms
Therapy recommendations
- For non-active omarthrosis: analgesic/pain reliever paracetamol (best tolerated).
- In activated omarthrosis (abraded cartilage or bone inflamed): nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., selective COX-2 inhibitors (e.g., etoricoxib) or diclofenac [no long-term therapy!]Note: No diclofenac in cardiovascular risk! Affected are patients with heart failure (cardiac insufficiency) of NYHA classes II to IV, coronary artery disease (CAD, coronary artery disease), peripheral arterial occlusive disease (CAD) or cerebrovascular disease.
- If necessary, glucocorticoids; the effect of intra-articular (“into the joint cavity”) injection is not assured, but may be administered in cases of inflammation that cannot be controlled otherwise.
Further notes
- Intravenous administration (administration) does not provide advantages over oral administration.
- Continuous therapy should not be used.
- Different NSAIDs should not be combined!
- Alternative therapy for high cardiovascular/gastrointestinal risk → conventional NSAIDs + low-dose acetylsalicylic acid (ASA) + proton pump inhibitors (PPI; acid blockers) (recommendation of the Drug Commission of the German Medical Association).
- Caveat. According to a cohort study, 1-year mortality rates were significantly increased after short- to medium-term tramadol use as an analgesic in patients with osteoarthritis compared with NSAIDs (naproxen, diclofenac, celecoxib, and etoricoxib). Death rates under codeine were similar to those under tramadol in a head-to-head comparison (34.6 and 32.2/1,000 person-years, respectively).
Glucocorticoids
- Mode of action: Glucocorticoids have antiphlogistic and antiedematous (anti-inflammatory and decongestant) effects.
- The effect in intra-articular injection is controversial (EULAR guideline: 1b; OARSI guideline: suitable; AAOS guideline: not suitable), but can be administered in cases of inflammation that cannot be controlled otherwise.
There are other drugs that are intended to relieve and combat the discomfort and symptoms of osteoarthritis. However, the effectiveness of these agents is not ensured. Therefore, no recommendation can be made for them.
Supplements (dietary supplements; vital substances)
Usually, drugs from the above groups are taken in combination with chondroprotectants/cartilage-protecting agents (e.g., glucosamine sulfate, chondroitin sulfate) to inhibit cartilage-degrading substances and provide relief or improvement of pain.
For more information on chondroprotectants, see the following chapter.
Note: Chondroprotectants should preferably be taken in combination with other bone-active vital substances, such as vitamins (C, D, E, K) and omega-3 fatty acids (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)), if appropriate.
