(1) non-steroidal anti-inflammatory drugs are currently the drugs of choice to control the symptoms associated with osteoarthritis, by anti-inflammatory, antipyretic, analgesic, alleviate the symptoms of inflammation caused by local bone irritation, reduce joint swelling, etc.. Currently, the commonly used oral NSAIDs in China include aspirin, ibuprofen, loxoprofen, diclofenac, etodolac, nabumetone, meloxicam, nimesulide, ericiclib, celecoxib, etoricoxib, etc. According to the different selectivity to the action target cyclooxygenase (COX), NSAIDs are divided into non-selective COX inhibitors and selective COX-2 inhibitors. For those who have previous history of peptic ulcer, COX-2 inhibitors can be chosen, such as ericiclib, 100mg once, twice a day; etoricoxib, 30-60mg once, once a day; celecoxib, once 200 mg once a day.
The commonly used non-selective COX inhibitors aspirin, 300-600mg once, 3 times a day; ibuprofen, 200-400mg once, every 4-6 hours; loxoprofen, 60mg once, 3 times a day, etc.
Adverse reactions of NSAIDs mainly include gastrointestinal adverse reactions, such as nausea, vomiting, abdominal pain, poor appetite, etc. In severe cases, there are peptic ulcers, bleeding, perforation, etc.; concomitant use of proton pump inhibitors such as omeprazole, lansoprazole, pantoprazole, etc. is recommended. Others are nephrotoxicity, peripheral cytopenia, coagulation dysfunction, etc. Allergic reactions such as rash, asthma, etc. occur in a few patients.
Medication advice: 1. NSAIDs that promote the synthesis of cartilage matrix proteoglycans, such as loxoprofen, ericiclib, celecoxib, diclofenac, meloxicam, etc., should be used. 2. 1 NSAIDs in sufficient doses for 1 to 2 weeks is ineffective before changing to another; avoid taking 2 or more NSAIDs at the same time. 3. do not take the drug on an empty stomach; alcohol consumption is not recommended during the drug administration. Do not combine with anticoagulants (e.g. warfarin), which may increase the risk of bleeding.4. Choose special dosage forms if necessary, such as enterolysis to reduce the irritation of the gastric mucosa, and extended-release dosage forms to better control the blood concentration and improve patient compliance with the drug.5. Elderly patients are advised to use NSAIDs with a short half-life, such as diclofenac, indomethacin, and loxoprofen sodium tablets.
Contraindications : Active peptic ulcer and recent gastrointestinal bleeding, hypersensitivity to aspirin or other NSAIDs, hepatic insufficiency, renal insufficiency, severe hypertension and congestive heart failure, hemocytopenia, pregnancy and lactating women.
Acetaminophen inhibits the synthesis and release of prostaglandin E 1, bradykinin and histamine, etc., to increase the pain threshold and play an analgesic role.
Dosage recommendation: Patients with osteoarthritis with mild to moderate pain usually use acetaminophen, 0.5 g each time, 3-4 times a day, with the maximum daily dose not exceeding 2 g. The dose should be reduced by half if there is liver and kidney disease, intake of dangerous doses of alcohol, or the elderly; patients with osteoarthritis who do not respond well to acetaminophen treatment may use NSAIDs on an individual basis.
Adverse effects: Rash, urticaria, drug fever, and granulocytopenia are occasionally seen. Long-term heavy dosing can lead to abnormal liver and kidney function.
Contraindications : Contraindicated in patients with hypersensitivity and severe hepatic and renal insufficiency.
2.Delaying the progress of disease
Diacerein is an anthraquinone-derived drug with natural anti-inflammatory properties found in the genus Cinnamomum, which can inhibit cartilage degradation, promote cartilage synthesis and inhibit synovial inflammation, which can effectively improve the symptoms of osteoarthritis, reduce pain, improve joint function, and delay the progression of osteoarthritis, and can be used for analgesia in patients with chronic pain in osteoarthritis.
Dosing advice: Diacerein can cause mild diarrhea and it is recommended to take 1 capsule daily by mouth after dinner for the first 4 weeks of treatment. Once the patient is comfortable with the drug, the dose should be increased to twice daily by mouth with a meal. Since diacerein becomes effective 2-4 weeks after treatment, it is recommended that it be given in combination with other analgesics or NSAIDs for the first 2-4 weeks, and the total duration of treatment should not be shorter than 3 months.
Adverse effects: Mild diarrhea is the most common side effect of diacerein treatment (incidence about 7%), which usually occurs within the first few days after treatment and in most cases disappears spontaneously with continued treatment.
Contraindications: It is contraindicated in patients with hypersensitivity to diacerein or a history of anthraquinone derivatives and in patients with previous intestinal disturbances (especially allergic colitis).
Glucosamine can provide substances for proteoglycan synthesis and replenish endogenous cartilage components; stimulate chondrocytes to produce proteoglycans with normal multimeric structure and promote synovial synthesis of hyaluronic acid; inhibit enzymes that damage cartilage and also inhibit the production of superoxide radicals.
Dosing advice: mild osteoarthritis, poor efficacy in end-stage osteoarthritis with severe wear and tear of articular cartilage. The clinical efficacy of these drugs in osteoarthritis is controversial, and different studies have come to different conclusions. Some studies suggest that these drugs have the effect of relieving pain symptoms, improving joint function, and delaying disease progression, but others suggest that they do not delay disease progression. They may be used selectively in patients with symptomatic osteoarthritis. Crystalline glucosamine sulfate is recommended in Europe as a long-term basic treatment for osteoarthritis of the knee.
For both glucosamine sulfate and glucosamine hydrochloride, glucosamine sulfate is less gastrointestinally irritating and more readily absorbed by comparison. Most studies suggest that continued use of 1500 mg glucosamine for more than 8 weeks is necessary to show some efficacy. It is recommended to be taken with or after meals to reduce gastrointestinal discomfort, especially in patients with gastric ulcers. Patients taking concomitant NSAIDs may need to reduce the dose of this product, or reduce the dose of NSAIDs.