The drug treatment of osteoarthritis should be based on the location of osteoarthritis patients and the extent of the disease, internal and external combination, individual, ladder drug treatment.
(1) non-steroidal anti-inflammatory drugs (NSAIDs) : it is the most commonly used drug to relieve pain and improve joint function in patients with osteoarthritis. This includes topical and systemic drugs.
Topical drugs: before the use of oral drugs, it is recommended to choose topical drugs, especially the elderly, can use a variety of NSAIDs class drugs gel paste, latex agent, paste, paste, such as flurbiprofen gel paste. Topical medicine can quickly and effectively relieve mild and moderate pain in the joints, and its gastrointestinal side effects are mild, but it is necessary to pay attention to the occurrence of local skin side effects. For moderate and severe pain can be combined with topical drugs and oral NSAIDs drugs.
Systemic application drugs: according to the route of administration can be divided into oral drugs, injections and suppositories, the most commonly used is oral drugs.
Principles of drug use: (1) assess risk factors before drug use, pay attention to the risk of potential medical diseases; (2) according to the individual situation of the patient, dose individualized; (3) try to use the lowest effective dose, avoid overdose and similar drugs repeated or superimposed use; 3 months after the use of drugs, according to the condition of the choice of the corresponding laboratory test.
Note: the efficacy and adverse reactions of oral NSAIDs drugs are not exactly the same for different patients. The drug instructions should be read and the risks of taking NSAIDs drugs should be evaluated, including the selective use of NSAIDs drugs after the risk of upper digestive tract, brain, kidney and cardiovascular diseases. If patients have a high risk of upper gastrointestinal adverse reactions, selective cox-2 inhibitors can be used. For example, non-selective NSAIDs drugs should be used together with H2 receptor antagonist, proton pump inhibitor or misoprostol and other gastric mucosal protective agents. NSAIDs should be used with caution in patients with a high risk of cardiovascular disease. Taking two different NSAIDs drugs orally at the same time will not increase the efficacy, but will increase the incidence of adverse reactions.
(2) analgesic drugs: for those who are not effective or intolerant to NSAIDs drug treatment, the combination of non-nsaids drugs, opioid analgesics, acetaminophen and opioid drugs can be used. However, it is important to note that the incidence of adverse reactions or addictions to opioids is relatively high and caution is recommended.
(3) drugs injected into the joint cavity: can effectively relieve pain and improve joint function. However, this method is invasive, may increase the risk of infection, must be strictly aseptic and standardized operation. Such drugs include glucocorticoids, sodium hyaluronate, medical chitosan, growth factors and platelet-rich plasma.
(4) slow acting drugs to relieve the symptoms of osteoarthritis (SYSADOAs) : including diacetaminophen, glucosamine, chondroitin sulfate, etc. These drugs are generally characterized by a lag in the response to painful symptoms of osteoarthritis. In most cases, it takes two to three weeks for the drug to begin acting and regulating the pain. Some studies have suggested that these drugs can relieve pain, improve joint function, and slow the progression of the disease, but others have suggested that they do not slow the progression of the disease. Currently, the clinical efficacy of these drugs for osteoarthritis is still controversial, and can be used selectively for symptomatic osteoarthritis patients.
(5) anti-anxiety drugs: it can be applied to patients with long-term and persistent pain in osteoarthritis, especially patients who are not sensitive to NSAIDs drugs, and can achieve the purpose of relieving pain and improving joint function in a short term. However, attention should be paid to adverse drug reactions, including dry mouth and gastrointestinal reactions. At present, further long-term follow-up studies are needed to prove its role in osteoarthritis and its use is recommended under the guidance of a specialist.
(6) proprietary Chinese medicine: oral proprietary Chinese medicine and topical ointment containing active ingredients such as artificial tiger bone powder and iron lock. At present, some studies have shown that Chinese traditional medicine can alleviate pain, delay the disease course of osteoarthritis and improve joint function in a variety of ways, but the mechanism of its action and long-term efficacy still need high-level research evidence.