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What are the long term effects of pharmaceuticals in managing osteoarthritis?3rd April 2018
Osteoarthritis is a condition that affects your joints. It is caused by everyday wear and tear rather than any specific immune condition, but it is still painful and can be debilitating. It is caused when the cartilage that covers and protects the ends of your bones, where they join, becomes roughened and thickened. The bone underneath the cartilage also thickens, as do the ligaments, the synovium (the inner layer of the joint capsule) and the capsule itself. Sometimes extra synovial fluid is produced, which causes the joint to swell.
The changes within the joint are not always painful or problematic, especially to begin with. When the cartilage becomes really thin, the ends of the bones rub together. The bones grow outwards, developing bony spurs called osteophytes. The wear on the bone, the osteophytes and the loss of cartilage can change the shape of your joints and cause pain and stiffness.
There is no cure for osteoarthritis; however, there are treatments that can reduce the pain and improve the patient’s quality of life. The condition does not have to get worse, especially once it has been correctly diagnosed, and there are several ways of reducing the effect it has on people’s lives. Most doctors will recommend a combination of medication and lifestyle changes, with surgery an option in very severe cases.
Medication for osteoarthritis, whether prescribed or over the counter, is mainly focussed on relieving and controlling the pain caused by damaged joints. All medications have some side effects and it is important to be aware of what these are. This is especially true when dealing with osteoarthritis, as the condition has no cure. Taking medication over a long period can make side effects worse, or lead to other health problems, which is why most doctors recommend that people with osteoarthritis make lifestyle changes in addition to taking medication.
The first place most people go to relieve pain is their local pharmacy, as over-the-counter pain remedies can be very effective; however, even when no prescription is needed, these medications can have quite serious side effects.
Paracetamol is safe for many people. Pregnant or breastfeeding women can use it, as can children over the age of two months. There are a few points to be aware of, however, even with this medication. People who have liver or kidney problems, who have alcoholism or who are very underweight should avoid it if possible; in addition, it can combine with other medications to cause unpleasant reactions. There have been some studies that suggest the long-term use of paracetamol can cause health problems in a small number of people.
There is a limit to the amount of paracetamol that you can take - as there is with any medicine - and taking too much paracetamol can damage your liver or kidneys. This is why doctors will often prescribe alternative pain relief if paracetamol is not working or is only working when taken very frequently.
NSAIDs (non-steroidal anti-inflammatory drugs)
There are two kinds of NSAIDs - traditional ones, such as ibuprofen, and COX-2 inhibitors - and they can be administered in creams in addition to in tablets. NSAIDs and COX-2 inhibitors are effective at reducing inflammation and pain, and work particularly well for patients who have osteoarthritis in their knees or hands.
If you take NSAIDs over a long period, they can damage your stomach lining. The same is true of COX-2 inhibitors. For this reason, doctors will usually prescribe PPI (proton pump inhibitor) medication at the same time. PPI medications reduce the amount of acid produced in the stomach; therefore, if the NSAIDs cause the stomach lining to thin, less damage will be done. PPI medication will come with its own set of side effects, of course, which can include headaches, diarrhoea, nausea and dizziness.
Opioids such as codeine or tramadol are prescribed when paracetamol does not work; they are used to control severe pain. Using codeine, tramadol or other opioids can cause some unpleasant side effects. Nausea and drowsiness are quite common side effects of this kind of medication, as is constipation. If you are going to be using opioids over a long period, your doctor will probably prescribe laxatives to offset the constipation; again, laxatives can also have side effects.
Capsaicin cream is prescribed for patients who are not responding to other pain medication. It works by blocking the pain transmitters - the nerves that tell you when you are in pain. It takes some time to become effective, with patients often having to wait up to one month to experience the full effect.
Capsaicin cream is made from chilli’s, so you might feel a burning sensation after you use it. It is also really important that your hands are washed thoroughly after use. If capsaicin cream is transferred to a sensitive area, such as the genitals, the eyes, the nose or the mouth, it can be extremely painful. It is not likely to do any lasting damage, but it is an unpleasant experience that is best avoided.
If the pain from osteoarthritis is really intense and the patient does not respond to the other pain medications, doctors can prescribe corticosteroids as tablets or injections straight into the affected joint. Corticosteroids reduce pain and swelling, and can be very effective. If they work well for you, and the pain relief lasts for a prolonged time, injections can be given up to three times a year. There should always be a gap of at least three months between injections.
The side effects of corticosteroids are unlikely over the short term; however, long-term use can cause increased appetite and therefore weight gain. If you suffer from osteoarthritis, gaining weight can make the condition worse, as more strain is put on the affected joints. They can also cause mood changes and difficulty sleeping.
No medication is wholly without side effects, with the side effects usually becoming more likely if the medication is taken over a long period. This is why other kinds of treatment are so important for osteoarthritis sufferers.
Exercise and weight loss can really help to reduce the strain on your joints and therefore the pain that you experience. Being overweight can put extra stress on your joints and if you do not take much exercise, your joints will stiffen up and become more painful. Eating healthily and exercising regularly will improve your overall health and will have specific benefits if you suffer from osteoarthritis.
If you want to exercise more frequently, it is important to take advice as to which kind of exercise you should do, as some exercise can put extra strain on certain joints. It is also worth doing some research into the kinds of braces and supports that are available for people with injuries or health conditions. New materials and designs mean that braces and supports are now available that are lightweight, flexible and even waterproof, allowing you to take part in a wider range of activities.
One of the most important things you can do, whether you suffer from osteoarthritis or from any other medical condition, is to find out more about it. Ask your doctor, ask your physiotherapist, and check out reputable sources of information such as the NHS website. Simple as it sounds, read the information leaflets that come with your medication. In this way, you can avoid side effects, or at least keep them to a minimum.