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During the early stages of osteoarthritis (OA), nonprescription drugs are the first choice of treatment (when deemed appropriate for the individual). The goal should be to control the patient's pain and other symptoms, as well as to enhance quality of life and the ability to function in daily routines (Tables 1 and 2).
Typically, when no contraindications are present, acetyl-P-aminophenol (acetaminophen) is used initially to treat mild-to-moderate pain associated with OA. Because inflammation often is associated with OA, however, nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly utilized agents for treating OA. In 2005, the FDA requested that manufacturers of all OTC NSAID products revise their patient information labels to include warnings about increased cardiovascular and bleeding risks.1
Other types of therapies may be used in conjunction with nonprescription agents:
Alternative therapies, such as glucosamine and chondroitin, are becoming increasingly popular and are sold as dietary or nutritional supplements. Research suggests that glucosamine aids in cartilage repair and formation, and chondroitin is a protein that allows for cartilage elasticity.2 These supplements should not be used by pregnant or nursing women or patients who are allergic to seafood. Individuals with preexisting medical conditions or those on other medications always should check with their health care provider prior to taking any of these agents. Other alternative therapies on the market are methylsulfonylmethane and S-adenosyl-L-methionine.
The Role of the Pharmacist
Pharmacists can play a fundamental role in helping patients make proper choices when treating mild-to-moderate OA. In most cases, nonprescription analgesics can provide relief when used appropriately. Pharmacists should encourage patients to incorporate nonpharmacologic therapies into their treatment plans and to make routine follow-up visits to their health care providers.
Ms. Terrie is a clinical pharmacy writer based in the northern Virginia area.