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Arthritis – Osteoarthritis

Conventional Treatment Options

Since there is no cure for ostheoarthritis (OA), most available treatments are aimed at controlling pain and maintaining joint function (Kapoor 2011). If OA pain is unable to be controlled with less invasive measures like physical therapy and exercise, treatment options ranging anywhere from intermittent use of analgesics to total joint replacement surgery are available (Strand 2011).

Physical Therapy/ Exercise

In most cases, ostheoarthritis (OA) treatment should begin with the safest and least invasive therapies (e.g., exercise) (Sinusas 2012). This is because physical activity is associated with significant health benefits among OA patients (e.g., preventing obesity, conserving physical function, and contributing to normal joint health) (Egan 2010).

Exercise programs consisting of muscle strengthening and range-of-motion movements are associated with significant improvements in OA symptoms (Sinusas 2012). Similarly, aerobic activity can reduce pain and disability in people with OA of the knee (Jansen 2011).

In patients who are either unable or unwilling to participate in vigorous exercise, walking for approximately 30 minutes per day, at least 3 days per week, can contribute to a reduction on OA symptoms (Ng 2010).

Pharmacologic Treatment and Other Therapies

Acetaminophen. Acetaminophen is usually the first-line pharmacologic therapy in conventional medicine for ostheoarthritis (OA) (Lim 2011; Woodcock 2009). If acetaminophen is unsuccessful, the next pharmacological treatment level varies depending upon patient-specific factors (e.g., treatment success), but usually involves the use of one or more of the following options (Lim 2011; Scheiman 2010; Howes 2011):

  • Topical non-steroidal anti-inflammatory drugs (NSAIDs)
  • Topical capsaicin
  • Oral NSAIDs
  • Intra-articular corticosteroid and hyaluronic acid injections
  • Opioids

The Potentially Lethal Side Effects of Over-the-Counter Pain Medications

In an effort to relieve suffering, many ostheoarthritis (OA) patients turn to non-prescription over-the-counter (OTC) analgesics such as acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs) (Hersh 2007). However, since these drugs do not require a prescription, patients may incorrectly assume that they do not need to be as careful about safety as they would with a prescription analgesic. Therefore, it is important for patients to become educated about serious adverse side effects that can occur with popular non-prescription OTC analgesics (Wilcox 2005).

Acetaminophen is one of the most widely used analgesics in the United States. In 2008, approximately 25 billion doses of acetaminophen were sold in the US alone (FDA 2009). Unintentional acetaminophen overdose is responsible for approximately 15,000 hospitalizations each year, and is the leading cause of acute liver failure in the US (Woodcock 2009).

Patents taking acetaminophen should follow these recommendations (Saccomano 2008):

  • Do not to exceed a maximum dose of 4 grams/day
  • Remember that many prescription pain medications also contain acetaminophen
  • Recognize that acetaminophen is also called APAP, paracetamol, and acetyl-para-aminophenol
  • Do not use with other NSAIDs (without medical consultation), which increase the risk of kidney toxicity
  • Do not take with alcohol, which significantly increases the risk of liver toxicity
  • For those taking acetaminophen for pain relief, aggressive supplementation with hepato-protective nutrients such as N-acetyl-cysteine (NAC) and milk thistle extract may provide a means of reducing drug-induced liver damage (Abenavoli 2010; Bajt 2004).

NSAIDs such as ibuprofen and naproxen are also associated with significant adverse effects such as gastrointestinal bleeding, peptic ulcer disease, high blood pressure, edema (i.e., swelling), kidney disease, and heart attack (Peterson 2010). For example, long-term use of NSAIDs can lead to impaired glomerular filtration, renal tubular necrosis, and eventual chronic renal failure by disrupting prostaglandin synthesis, which can impair renal perfusion (Weir 2002). Even in NSAID users without overt kidney dysfunction, subclinical irregularities in kidney function are often observed (Ejaz 2004).

Aspirin (a type of NSAID) is commonly used to treat minor aches and pains, as well as being recommended at low doses for heart protection and stroke prevention. Aspirin irreversibly inhibits an enzyme called cyclooxygenase-1 (COX-1) in platelets, which is why it poses a greater risk of bleeding (i.e., hemorrhage) than other NSAIDs (Hersh 2007). Therefore, patients taking aspirin should avoid the simultaneous use of anticoagulant drugs and/or alcohol (without talking to their doctor first). Aspirin can also cause mild side effects such as heartburn, nausea, vomiting, stomach ache, ringing in the ears, hearing loss, and rash (NIH 2011).