Drug treatment
1.Fast-acting symptom relief drugs
These drugs have a rapid analgesic and symptomatic effect, but do not affect the pathology of osteoarthritis and the structure of the lesion, including analgesics, non-steroidal anti-inflammatory drugs and glucocorticoids.
Analgesics should be preferred for osteoarthritis, and NSAIDs can be used for those with joint inflammation where analgesics are ineffective, inappropriate, or have no apparent effect. The commonly used analgesic is acetaminophen (paracetamol) 0.3~0.6/time, 2~3 times/day, which can be used alone or in combination with non-carrier anti-inflammatory drugs, which are first recommended abroad for good pain relief, less adverse effects and low cost. In addition analgesics have opiate-like substances: dextropropoxyphene codeine, tramadol, etc.
Non-steroidal anti-inflammatory drugs have a better therapeutic effect on inflammatory manifestations such as joint pain swelling fluid accumulation and activity limitation in patients with osteoarthritis. Such drugs are divided into two categories according to their effects on bone metabolism.
(1) Non-steroidal anti-inflammatory drugs that inhibit cartilage synthesis: salicylic acid, aspirin, anti-inflammatory pain, etc.
(2) NSAIDs with less adverse effects on cartilage: diclofenac sodium, acemeticin, sulforaphane, etc. Large doses of non-carrier anti-inflammatory drugs exert anti-inflammatory effects, and small doses of NSAIDs exert analgesic effects.
For the treatment of osteoarthritis, the dose of NSAIDs should be small, and try to use NSAIDs that selectively inhibit cyclooxygenase-2, such as nimesulide 0.1 orally twice daily, meloxicam 15mg orally once daily, etc. Currently, there are also specific cyclooxygenase-2 inhibitors rofecoxib and celecoxib available. For acute arthritis, tendonitis line joint cavity or lesion local injection of glucocorticoids that other treatments have not been effective may be effective.
2, slow-acting symptom relievers and chondroprotective agents
These drugs can slow down or reverse the degradation of osteoarthritic cartilage, relieve pain and improve joint function, and interfere with the pathological process of osteoarthritis. The effect is generally slow. However, the efficacy can last for a period of time after stopping the drug, such as hyaluronic acid and glucose sulfate based, which may belong to this category.
(1) Glucosamine sulfate exogenous glucosamine sulfate can replenish the lost components of cartilage matrix, inhibit the inflammatory process, delay the development of osteoarthritis, relieve pain and improve joint movement. It is easily absorbed orally, 0.25 to 0.5 three times a day for 4 to 12 weeks, with improvement of symptoms after 2 weeks of treatment, and is prohibited for those who are allergic to glucosamine sulfate.
(2) Hyaluronic acid The size of viscoelasticity and molecular shielding effect of hyaluronic acid solution is related to the molecular weight and concentration of hyaluronic acid. The therapeutic effect of hyaluronic acid is manifested by relief of joint pain, increased mobility and reduction of inflammation, which usually occurs within a week after treatment and is maintained for weeks to months. The application of hyaluronic acid solutions with large molecular weight results in a longer half-life in the joint cavity and fewer doses, while hyaluronic acid solutions with smaller molecular weight result in a greater number of doses. At present, the domestic hyaluronic acid products include sodium vitreous acid injection (SPECTRO), molecular weight (1.5~2.5)×106, in the form of 20mg/2ml, which is injected into the joint cavity once a week for five consecutive weeks as a course of treatment, and the therapeutic effect can last for about six months. Imported hyaluronic acid has Xinwei can, molecular weight of 6 × 106, generally injected once a week 2ml, three times for a course of treatment, the effect can be maintained for about a year; However, recent medical research has proved that intra-articular injection of sodium vitrate in osteoarthritis of the knee joint is not effective, which is questionable.
(3) diacerein (diacerein ampicillin): the product is a rhubarb extract, the active ingredient is diacetyl rhubarb acid. Experimental studies have proved that this product is used for the treatment of osteoarthritis by inhibiting the production and release of IL-1B and oxygen free radicals, inhibiting the activity of metalloproteinases and stabilizing the lysosomal membrane and exerting anti-inflammatory and protective effects on joint cartilage, improving the course of osteoarthritis.
(4) tetracycline family antibiotics: tetracycline family is a broad-spectrum antibacterial agents, it was found that it can also play a condition-improving effect on osteoarthritis, rheumatoid arthritis. In particular, doxycycline and dimethylaminotetracycline can inhibit matrix metalloproteinase activity in vitro. Clinical study found that treatment with doxycycline 100mg once or twice daily for 5 days significantly inhibited the activity of gelatinase and collagenase in cartilage extracts from patients with osteoarthritis.
(5) Sodium pentasan polysulfate inhibits metalloproteinase and granulocyte elastase activity, attenuates the ability of leukocytes to produce cytokines and prostaglandins, improves subchondral blood circulation in osteoarthritis, and protects cartilage. Generally, 3mg/kg is injected intramuscularly once a week for four weeks.
3.Other drugs
(1) Bone resorption agents Bisphosphonates can inhibit collagenase and prostaglandin activity, improve the aggregation of glycoproteins, thicken the cartilage layer, and inhibit osteoclast activity to reduce bone resorption.
(2) Cytokines such as insulin growth factor-1, transforming growth factor b, interleukin-1 receptor antagonist or tumor necrosis factor-α receptor antagonist can delay and prevent cartilage degradation in osteoarthritis, increase cartilage matrix synthesis and promote cartilage repair, but further clinical trials are needed.
(3) Vitamins A, C, D and E: Attention has recently been focused on vitamins as a way to prevent and improve osteoarthritis pain and disability. Vitamins A, C and E are the main antioxidants in food and have proven to have potential antioxidant effects on the osteoarthritic process. Vitamin D plays a role in osteoarthritis through its effects on bone mineralization and cell differentiation. Despite this, there are few reports of osteoarthritis treatment with the above vitamins alone.1 A report presenting 29 cases of osteoarthritis treated with vitamin E 600 MG/day for ten days showed that 52% of patients had significant pain relief, while only 4% of the placebo group improved. It seems that the use of the above vitamins as an adjunctive treatment for osteoarthritis is not without benefit.
4.Treatment strategy
Early diagnosis, early treatment and long-term treatment are the treatment strategies for osteoarthritis. In other words, prevention and comprehensive treatment should be started when the patient is symptomatic, but the articular cartilage is not yet obvious, the joint space is not yet narrowed, and the bone is not yet visible, with long-term follow-up. Direcgonine may be used in combination with glucosamine sulfate or alone at the beginning of treatment. Anti-inflammatory and analgesic drugs are used at any time for a short period of time depending on the patient’s pain or swelling. Hyaluronic acid and other complementary treatments have good effects on improving symptoms, function and quality of life, and should be promoted for patients with indicated symptoms and conditions.