[The role of nonsteroidal anti-inflammatory drugs, oral preparations, and viscosupplementation in conservative treatment of cartilage lesions].

Abstract

Osteoarthritis is one of the most common disabling conditions in elderly population. Its current treatment includes not only eliminating symptoms, but also slowing down the degenerative process and achieving functional improvement. When the patient does not benefit from nonpharmacologic measures such as loosing weight, drug therapy is needed, which includes analgesics, weak narcotic drugs, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, corticosteroids, viscosupplementation, and slow-acting drugs used in osteoarthritis. Among these, simple analgesics are first-line treatment option for osteoarthritis owing to successful relief of symptoms and negligible side effects. Nonsteroidal anti-inflammatory drugs, in spite of providing greater analgesic effect, have to be used carefully for their gastrointestinal and chondrodestructive adverse effects. COX-2 inhibitors are being reassessed for their cardiovascular adverse effects and research is in progress for further improvement. Although viscosupplementation is effective in the short-term, no long-term benefits have been observed. There is no convincing evidence for the efficacy of slow-acting drugs such as glucosamine and chondroitin sulphate given as nutritional support. Other treatment modalities currently evaluated are biphosphonates, hormones, metalloproteinase inhibitors, cytokines, nitric oxide, growth factors, and gene therapy.