Alternative Treatments for Conditions or Diseases

What are therapeutic options for osteoarthritis

Acetaminophen/paracetamol (Tylenol®)
First line in treating osteoarthritis.
Dose: 325-650 mg every 4-6 hours, with a maximum of 4000 mg/day
6 doses of 650 mg is just below 4000 mg
Caution in:

Patients with liver disease
Chronic alcohol users

NSAIDs
Second line in treating osteoarthritis.
Examples of NSAIDs and doses
Ibuprofen –

1200 – 3200 mg/day in 3-4 divided doses, with a max dose of 3200 mg/day
4 doses of 800 mg reaches the maximum dose of 3200 mg.

Naproxen sodium (Aleve®)
275 – 550 mg twice a day, with a max dose of 1375 mg/day
2 doses of 550 mg reaches just below the max dose of 1375mg/day. (5 doses of 275 mg equates to 1375 mg. However, note that naproxen should only be taken twice a day.)

Celecoxib (Celebrex®)
100 mg twice daily or 200 mg daily, with a max dose of 200 mg/day.
Side Effects:
GI
Nausea
Dyspepsia
Anorexia
Abdominal pain
Flatulence
Diarrhea
Kidney diseases
Topical Therapies
Usually used in combination with other medication.

Can be used alone for mild pain.
Diclofenac (Solaraze®, Voltaren Gel®)
Lower extremity – use 4g four times daily
Upper extremity – use 2g four times daily

Capsaicin
Apply four times daily, takes 2 weeks to work
Side Effects:
Burning
Stinging

Erythema

Glucosamine
Considered a supplement

Not for patients allergic to oysters, crab shells, and shell fish.
Dose: 500 mg three times daily
Should be taken for at least 1 month before improvement occurs.

Chondroitin Sulfate
(Rare) Not for patients allergic to shark and cow cartilage.

Dose: 400 mg three times daily
Should be taken for at least 1 month to see results.
Intra-articular Corticosteroid Injections
For painful flares of osteoarthritis of the knees of hips.
Drugs:
Methylprednisolone (Medrol®)
Triamcinolone (Aristocort®)
Dose is based on size of joints.
Side Effects
Pain
Discomfort
Breakdown of cartilage or bone with long term use

Do not inject more than 3 or 4 times in 1 year.
A maximum of 1 injection every 3 months.

Hyaluronate Injections
Only for the knees.
Drugs & Doses:
Hyalgan® – weekly injection of 2 mL for 5 weeks.

Supartz® – weekly injection of 2 mL for 5 weeks.

Synvisc® – weekly injection of 2 mL for 3 weeks.
Orthovisc® – weekly injection of 2 mL for 3 weeks.

Side Effects:
Pain
Discomfort

Other Agents
Tramadol – add on to NSAID
Tetracycline/Doxycycline – delays loss to narrowing of joint spaces
Narcotic analgesics





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