2017 HCHB_digital

Osteoarthritis
Osteoarthritis is the most common form of arthritis affecting almost 50% of all
people over 60 and almost everybody over the age of 80. It is sometimes called
"wear and tear" or degenerative arthritis.
Osteoarthritis occurs when the cartilage that covers the end of each bone
in a joint starts to break down and wear away, leaving the ends of the bones
unprotected. This affects the gliding surface of the bones in the joint and as a
result they become painful and difficult to move. After a while, the joint can
lose its shape and the bone underneath thickens and grows out the sides,
further reducing movement. The large weight-bearing joints (knees, hips and
spine) are most often affected, although osteoarthritis can also affect the
ankles, neck, hands, lower back, base of the toes, and, as a result of injury or
stress, the wrist, elbow, shoulder or jaw.
Osteoarthritis is caused by a combination of factors, such as aging, genetic
defects in joint cartilage, joint injury, joint stress or overuse through sports or
certain occupations, and being overweight. There is no one specific cause.
Symptoms
Osteoarthritis is often very mild and some people may not realise they have it
until an x-ray reveals joint changes. Symptoms tend to start in middle age and
morning stiffness in a joint (lasting less than 30 minutes), or a deep ache in a
joint which is hard to localise, may be the only initial sign.
Twinges of pain may be experienced in older people which tend to be relieved
with rest and warmth. People with more pronounced osteoarthritis are likely to
have a more persistent pain that increases with use and decreases with rest.
Other symptoms include:
• stiffness in a joint when the joint has been rested
• swelling of the joint caused by an increase in synovial fluid production
• bony growths (Heberden's nodes) in finger joints – more common in women
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Combination analgesics
Topical non-steroidal
anti-inflammatory agents
(NSAIDs)
Rubefacients (‘heat’
rubs)
Other topical
applications
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, paracetamol (Panadol range, Paracare)
[PHARMACY ONLY MEDICINE] eg, Panadol Osteo*
[GENERAL SALE]
eg, ibuprofen 25s (Advil, Nurofen), naproxen (Sonaflam)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Osteo Tabs, Voltaren
Rapid 25)
[GENERAL SALE] eg, ibuprofen + paracetamol
(Maxigesic [16], Nuromol [12])
[PHARMACY ONLY MEDICINE] eg, ibuprofen +
paracetamol (Maxigesic [50, 100], Nuromol [24, 48])
[PHARMACIST ONLY MEDICINE]
eg, ibuprofen + codeine (Ibucode Plus, Nurofen Plus)
paracetamol + codeine (Panadeine, Panadeine Extra)
[GENERAL SALE]
eg, ibuprofen (Nurofen Gel), diclofenac (Voltaren
Emulgel, Voltaren Osteo Gel 12 Hourly*)
[PHARMACY ONLY MEDICINE]
eg, etofenamate (Rheumon Gel)
[GENERAL SALE]
eg, Deep Heat range, Ice Gel, Tiger Balm range
[GENERAL SALE]
eg, capsaicin (Zostrix*), Anti-Flamme Creme, AntiFlamme
Extra
Avocado-soybean unsaponifiables (ASU), bromelain,
chondroitin, fish oil, folic acid, glucosamine, green
lipped mussel, turmeric (eg Turmeric Extra Strength*)
Regular paracetamol, two tablets (1g) three or four times daily, is the first choice of treatment
for mild-to-moderate osteoarthritis. In many cases regular dosing is more beneficial than taking
only when the pain is bad. Maximum dosage of 4g/day may need to be reduced in the elderly.
Osteoarthritis is not normally an inflammatory condition but occasionally when there is
inflammation a NSAID may provide added benefit to simple analgesia. Ibuprofen is the NSAID
least likely to cause stomach irritation. NSAIDs may not be suitable for people on certain
other medications or with some medical conditions (eg, asthma, kidney disease – see Refer
to Pharmacist). Advise customer to stop taking if stomach upsets, increased bruising or
prolonged bleeding occur. Stronger NSAIDs are available on prescription. See Reference
Section, OTC Medicines – Precautions.
Simple analgesics (eg, paracetamol) should be tried first.
Warn customers that codeine is an addictive substance and should not be used for more than
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert for
any customers who may be misusing codeine-containing preparations.
NSAIDs may have gastric side effects, particularly long term. See Reference Section, OTC
Medicines – Precautions.
These treat the body’s inflammatory reaction to injury and reduce pain. These are usually
effective at relieving localised muscle aches or pains. Do not apply to broken skin or near the
eyes or mucous membranes. Wash hands after applying. Do not use under sealed dressings.
May, rarely, cause the same adverse effects as oral NSAIDs. Similar care and consideration
before use is recommended.
Cause blood vessels in the treated area to open and create a sense of warmth, which masks the
sensation of pain.
Capsaicin reduces levels of a chemical called substance P, which helps transmit pain impulses to
the brain. Has been used to relieve pain in osteoarthritis but may take up to four weeks for an
effect. Burning or tingling may occur briefly when applied to the skin.
Anti-Flamme helps to stimulate blood flow and has an anti-inflammatory and analgesic action.
ASUs help with pain and stiffness of osteoarthritis and may delay progression. Glucosamine
appears effective. Evidence for chondroitin has not been consistent.
Turmeric is reported to have a natural anti-inflammatory effect.
Products with an asterisk have a detailed listing in the Osteoarthritis section of OTC Products, starting on page 253.
Targeted Action
to relieve joint pain
Page 114 HEALTHCARE HANDBOOK 2017-2018 Common Disorders