NSAIDs not recommended for long-term use in osteoarthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs) have long been used to reduce pain and inflammation caused by osteoarthritis (OA). Until recently, these drugs were prescribed in fairly high doses and often for years, according to Steven B. Abramson, MD, director of rheumatology and professor of medicine, New York University School of Medicine. In 2006, the Osteoarthritis Research Society International formed an international committee to review all guidelines and evidence available on OA. Pharmacists might wonder what the long-term treatment options for OA are, if the NSAIDs are now out of favor. According to the new guidelines, no single drug or therapy is crowned as the ideal treatment for OA. Monitoring for adverse reactions and drug interactions is another invaluable pharmacy service, especially since OA patients are likely to take both prescription and OTC medications.

In 2006, the Osteoarthritis Research Society International (OARSI) formed an international committee to review all guidelines and evidence available on OA. The end result is a new set of 25, evidence-based recommendations for the treatment of hip and knee OA. Based on the evidence of potentially serious adverse reactions to NSAIDs, the committee has advised against the long-term use of NSAIDs to treat OA.

Although the OARSI committee decided that longterm NSAID use is not appropriate for OA, the committee also determined that NSAIDs can be effective, short-term pain relievers for the disease. Abramson, who is also president of OARSI, advised using the lowest effective dose of NSAIDs to treat OA symptoms. Once patients respond to treatment, they should be weaned off the medications. "Try and avoid long-term treatment if possible," he said.

Long-term treatment options

Pharmacists might wonder what the long-term treatment options for OA are, if the NSAIDs are now out of favor. According to the new guidelines, no single drug or therapy is crowned as the ideal treatment for OA. Instead, a multi-modal approach chosen from a menu of options should be tailored for each individual patient. The OA menu is a list of treatments that the committee agreed are effective for use in the disease. The treatments are grouped in categories of pharmacologie, nonpharmacologic, and surgical therapies.

Included in the pharmacologie category of the guidelines are NSAIDs, acetaminophen, glucosamine, chondroitin, weak opioids, narcotic analgesics, topical capsaicin, and topical NSAIDs. Also included are intraarticular injections of corticosteroids and hyaluronate. They are recommended on a temporary basis according to severity of symptoms.

The guidelines have been well-received by arthritis specialists, according to Abramson. The challenge now is to disseminate the information. This is one area where pharmacists can play a huge role. Abramson said pharmacists need to counsel patients that multiple therapies may be needed to treat their OA. Pharmacists can advise patients on proper OTC use and help them select braces and orthotics. Abramson also said that although NSAID use is risky, patients should not be denied prescription NSAIDs if OTC remedies are ineffective. Pharmacists should also be on the alert for patients with OA who present prescriptions for opioids. Although these drugs can be of use in OA, Abramson said patients should be evaluated by a rheumatologist if they are to the point of needing opioids. A good specialist will use therapies in combination and in proper order.

The complete guidelines can be viewed on the OARSI Web site: www.oarsi.org

sumber:

proquest.com