Osteoarthritis
Degenerative joint disease affecting articular cartilage, subchondral bone, joint capsule, and periarticular tissues. Most commonly involves knees, hips, and hands.
ICD-10 M198 drugs
Also known as: OA, Degenerative joint disease, DJD
Drugs used for this condition
- ADiclofenacFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)For osteoarthritis, NICE OA 2022 recommends starting with topical NSAIDs – diclofenac gel applied to the affected joint 3–4 times daily. Topical form provides local effect with minimal systemic exposure. Oral diclofenac is used when topical therapy is insufficient. Due to high cardiovascular risk, short courses are preferred.
- AIbuprofenFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)NSAIDs are first-line in osteoarthritis when paracetamol provides insufficient relief. Ibuprofen is prescribed at the lowest effective dose for the shortest duration. Patients with GI risk factors receive a concomitant PPI.
- BKetoprofenSecond line · Non-steroidal anti-inflammatory drug, propionic acid derivativeIn osteoarthritis ketoprofen takes off pain and morning stiffness but does not change the disease: it neither rebuilds cartilage nor slows progression. The AEMPS Fastum label names osteoarthritis among its indications. The 2019 ACR and Arthritis Foundation guideline for hand, hip and knee osteoarthritis builds treatment around loading, movement and weight, keeping NSAIDs for flares. The practical frame for an older patient with knee osteoarthritis: a short course rather than continuous use, with gastroprotection agreed in advance if aspirin, an anticoagulant or a systemic corticosteroid sits in the same regimen. With stable hypertension and reduced renal function, the effect of the NSAID on blood pressure and creatinine is checked rather than waited for.
- BLornoxicamSecond line · Non-steroidal anti-inflammatory drug, oxicamThe AEMPS Acabel label names symptomatic treatment of pain and inflammation in osteoarthritis in adults. On pain and stiffness lornoxicam works as well as other NSAIDs; on cartilage destruction it does nothing at all. The 2019 ACR and Arthritis Foundation guideline keeps loading, movement and weight at the base of treatment, which makes long-term NSAID use look like a substitute rather than therapy. The risk arithmetic is simple: the older the patient and the more drugs in the list that touch mucosa and platelets, the shorter the course should be. The label names the corticosteroid combination directly: ulcer and bleeding risk goes up.
- BParacetamolSecond line · Anilides. Analgesics and antipyreticsIn current NICE OA 2022 and ACR 2019 recommendations, paracetamol has moved to a second-line position in osteoarthritis in favor of topical NSAIDs and short-course systemic NSAIDs. It is recommended as an alternative in patients with NSAID contraindications. Long-term paracetamol for osteoarthritis has not shown substantial benefit over placebo in recent systematic reviews.
- CStinging nettle leafAdd-on therapy · Botanical supplement, stinging nettle leaf (Urtica dioica folium); in the EU registered as a traditional-use herbal medicinal product (EMA HMPC) for mild rheumatic pain and as a diuretic; sold on iHerb for «blood detox» and immunity. NOTE: nettle root (Urtica dioica radix) is a different product, indicated for benign prostatic hyperplasiaNettle leaf is an over-the-counter herbal remedy. The Chrubasik systematic review (Phytomedicine 2007) analysed available nettle studies in joint and muscle pain: small open-label studies and one RCT by Randall (J R Soc Med 2000) using topical leaf stinging on base-of-thumb pain showed moderate VAS pain reduction, but methodology was weak, blinding incomplete and samples small. EMA HMPC in 2010 recognised nettle leaf as adjunctive treatment in mild rheumatic and muscle pain based on traditional use, not RCT evidence. NICE 2022 and OARSI 2019 recommend exercise, weight control, paracetamol and topical NSAIDs as first line in osteoarthritis, with short-course oral NSAIDs if needed. Nettle is not in international or Spanish rheumatology guidelines; it is not considered a substitute for NSAIDs, only an option as adjunct therapy in mild pain. If nettle leaf is being considered as an add-on to standard treatment for mild joint pain, discuss with a doctor – when combined with NSAIDs, monitor blood pressure and potassium because nettle has a diuretic effect.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CCapsaicinNot recommended · Selective TRPV1 agonist, topical analgesic for neuropathic painLow-dose capsaicin 0.025–0.075% creams for knee and hand osteoarthritis is an option with limited evidence. Cochrane (Derry 2017): the effect is small, clinically marginal and evidence quality is low. EULAR and SER osteoarthritis guidelines do not list capsaicin as first line; they recommend topical NSAIDs, paracetamol and, for knee osteoarthritis, duloxetine or intra-articular corticosteroids. Use can be discussed when topical NSAIDs are not tolerated, but the effect is limited and burning often leads patients to discontinue.
- DGlucosamine + ChondroitinNot recommended · Chondroprotector. Glucosamine sulfate and chondroitin sulfate as monoproducts are registered by AEMPS as medicines for symptomatic treatment of mild-to-moderate knee osteoarthritis (Xicil, Pharma Mar; Condrosulf, Condrosan, Bioiberica). Fixed combinations are more often dietary supplements. In Russia, Dona and Structum are registered as medicinesGlucosamine-chondroitin is used in hip, hand and generalised osteoarthritis. Evidence base is weaker in hip and hand OA than in knee OA. Wandel 2010 (BMJ, 10 RCTs, 3803 patients) in hip and knee OA showed no clinically significant effect of any option. EULAR 2018 in hand OA and NICE NG226 2022 in any-site OA do not recommend glucosamine and chondroitin. First-line for OA is non-pharmacological (weight loss in hip and knee OA, base-of-thumb splinting in rhizarthrosis, exercise), topical NSAIDs, paracetamol as option, short courses of systemic NSAIDs, intra-articular steroid for knee and hip when insufficient effect. For severe OA – referral to orthopaedics for arthroplasty discussion. If glucosamine-chondroitin was offered as a substitute for exercise therapy and topical NSAIDs, consider seeking a second opinion from a rheumatologist.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit