Osteoarthritis Treatment Guidelines issued by the ACR.

New osteoarthritis treatment guidelines suggest the use of topical NSAIDs over oral for the over 75s (author Ragesoss)

New osteoarthritis treatment guidelines suggest the use of topical NSAIDs over oral for the over 75s (photo by Ragesoss)

Hurrah! Some sensible osteoarthritis treatment guidelines at last! I have long questioned the use of oral NSAIDs (non-steroidal anti-inflammatory drugs) for osteoarthritis. Osteoarthritis is, by definition, a non-inflammatory arthritis so an anti-inflammatory drug does nothing to help the pain of the actual wear and tear.

The American College of Rheumatology (ACR) Sub-Committee on Osteoarthritis Guidelines  has approved several new osteoarthritis treatment guidelines.

The new guidelines, published in the April issue of Arthritis Care & Research, conditionally recommend that healthcare providers consider topical nonsteroidal anti-inflammatory drugs (NSAIDs) as one option for the initial management of knee OA, along with other treatments including acetaminophen, oral NSAIDs, tramadol and intraarticular corticosteroid injections. In addition, the guidelines strongly recommend the use of oral or topical NSAIDs or intraarticular corticosteroid injections in patients with an unsatisfactory clinical response to full-dose acetaminophen, and furthermore strongly recommend topical over oral NSAIDs in those patients aged 75 years or older initiating NSAID therapy.

The last sentence is the most significant to me as this is only being advised for the over 75 age group. I was glad to hear Alfredo Bozzini,( Interim Chief Medical Officer, Pharmaceuticals, Covidien) say.

The American College of Rheumatology osteoarthritis treatment guidelines propose to advance the use of topical NSAIDs beyond what the American Geriatric Society and American Academy of Orthopedic Surgeons recommend,” said Dr. Joseph Markenson, attending physician at the Hospital for Special Surgery and professor of clinical medicine at Weill Cornell Medical College. “The updated guidelines are helpful to physicians in their clinical practice, especially when seeing patients over 75 years of age.”

Oral NSAIDs do help ease the pain in the muscles, tendons and ligaments (the soft tissue around the joint) but I have always been of the opinion that there are better ways of treating soft tissue. Oral NSAIDs have some terrible side-effects that I discussed the other day. If you use a good programme of physical therapy you will actually be improving their condition rather than masking the pain and you will not be poisoning your whole body with NSAIDs.

The use of a topical NSAID has two effects; first the anti-inflammatory effect of the drug which is being targeted to the area it is needed in but also the actual mechanical effect of massage for osteoarthritis is beneficial as well.

I hope that over time these new osteoarthritis treatment guidelines are issued for osteoarthritis patients of all ages. After all it is the young on oral NSAIDs who will suffer with the known long term side effects.

What do you think? Should you carry on using oral NSAIDs or switch to topical? Do you think NSAIDs should be used at all? Leave a comment and let us know!

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