Treatment of osteoarthritis resistant to initial pharmacologic therapy
- Kenneth C Kalunian, MD
Kenneth C Kalunian, MD
- Professor of Medicine
- University of California, San Diego School of Medicine
Osteoarthritis (OA) is a common cause of joint pain and disability. The treatment of OA is directed towards reduction of symptoms and the prevention of disability. There are no specific pharmacologic therapies that have been proven to prevent the progression of joint damage due to OA. (See "Clinical manifestations and diagnosis of osteoarthritis".)
The management of OA includes a combination of nonpharmacologic approaches, such as exercise and patient education; pharmacologic therapies, including oral, topical, and intraarticular medications; and surgical interventions, including total joint arthroplasty. The goal of finding disease-modifying agents for OA is being addressed through ongoing research.
The pharmacologic treatment of OA that is resistant to initial pharmacotherapy will be reviewed here. The initial pharmacotherapy (acetaminophen, nonsteroidal antiinflammatory drugs, and intraarticular glucocorticoids), clinical manifestations, diagnosis and differential diagnosis of OA; and the nonpharmacologic, surgical and investigational pharmacologic therapies for OA are presented separately. (See "Initial pharmacologic therapy of osteoarthritis" and "Nonpharmacologic therapy of osteoarthritis" and "Overview of surgical therapy of knee and hip osteoarthritis" and "Investigational approaches to the management of osteoarthritis" and "Clinical manifestations and diagnosis of osteoarthritis".)
The goals of therapy for patients with osteoarthritis (OA) are to control pain and swelling, minimize disability, improve the quality of life, and educate the patient about their role in disease management. Pain and other symptoms of OA can be confused with soft tissue processes such as bursitis at periarticular sites; in addition, pain in a particular area affected by OA may be referred from OA at other site or may be due to a nonarticular process. Thus, an important first step in management is to be reasonably certain that pain in a particular joint is indeed due to OA at that site. (See "Clinical manifestations and diagnosis of osteoarthritis".)
Management should be individualized to the joints involved, the patient's expectations, level of function and activity, the severity of the patient's disease, occupational and avocational needs and interests, and the nature of any coexisting medical problems. Subjective complaints and objective findings may guide the clinician in designing appropriate therapeutic goals together with the patient. The degree to which the treatment targets have been achieved should be periodically reassessed; such assessment can facilitate collaborative decision-making with the patient regarding whether and what adjustments may be needed in the treatment program.
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- Nonpharmacologic therapy
- Initial pharmacotherapy
- Resistant to initial drug therapy
- When to refer
- RESISTANT TO INTRAARTICULAR GLUCOCORTICOIDS
- Intraarticular hyaluronans
- - Efficacy of hyaluronan compounds
- Comparison with NSAIDs
- Comparison with intraarticular glucocorticoids
- - Adverse effects
- - Does molecular weight matter?
- - Hip
- RESISTANT TO NSAIDS AND JOINT INJECTIONS
- Opioid analgesics
- OTHER MEDICATIONS
- SUMMARY AND RECOMMENDATIONS