Therapeutic Objective
- Relief of symptoms
Therapy recommendations
- For non-active rhizarthrosis: analgesic/pain reliever paracetamol (best tolerated).
- In activated rhizarthrosis (abraded cartilage or bone material 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 in any other way [note: prone to complications and of doubtful effect].
- See also under “Further therapy/conventional non-surgical therapy methods”: percutaneous radiotherapy.
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).
Supplements (dietary supplements; vital substances)
Usually, medications 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.
