Osteoarthritis in community pharmacy

What is osteoarthritis?

Osteoarthritis is a condition which affects as many as 1 in 5 Australians1. It is a painful condition affecting the joints and cartilage, typically presenting as knee, hip, or hand joint inflammation and often involving damage to the surrounding cartilage, tendons and ligaments. Joint pain in osteoarthritis can range from being very mild or be quite debilitating, and may be accompanied by stiffness or loss of movement2. Arthritis is a condition which is prevalent in pharmacies around Australia, and pharmacists are in an optimal position to help patients develop a holistic approach to managing their symptoms.

Because the primary symptoms of osteoarthritis can be mistaken for other conditions, it is important to ensure a proper diagnosis before commencing treatment.

How does arthritis affect our communities?

Arthritis can be debilitating in many people and lead to decreased ability to work, exercise or socialise. Because it is difficult to remain physically active for people with more severe arthritis, the possibility of gaining weight and developing conditions such as hypertension or dyslipidemia is also increased. Research has shown that obesity may increase the risk of developing arthritis, and that weight loss can help to reduce the symptoms of those with arthritis3. For these reasons, it is essential for health professionals to stress the importance of a healthy diet, appropriate exercise and adequate pain management in people with arthritis so that they can maintain optimum health and well-being.

How can we manage osteoarthritis in the pharmacy?

The primary goal in osteoarthritis is to minimise the symptoms the patient experiences and to reduce the risk of developing co-morbidities. There are numerous ways one can manage symptoms of arthritis in community pharmacies and, by educating the patient, we can help them to choose the best combination of management strategies to suit their needs.

Exercise & weight loss
This is especially important in those who are overweight, however, regular exercise can benefit anyone and will help to build and maintain strength and flexibility in arthritic joints. Weight loss will also reduce the stress on the joints of the knees and hips, which can help improve symptoms such as stiffness, and reduce pain in the long-term. The patient may also benefit from seeking physiotherapy to develop specific exercises that benefit a particular joint or muscle group.

Paracetamol
First-line therapy for osteoarthritis pain; paracetamol is a safe choice if the patient needs something to help manage their symptoms. Paracetamol has been shown to be effective in managing arthritic pain and is usually better tolerated than other options such as NSAIDs or opioids.

Topical products
Ideal for knees and hands or other small joints, topical NSAIDs or rubefacients may provide some mild symptom relief and have less systemic absorption than other treatment options. Products such as Nurofen or Voltaren gels and creams can provide some local pain relief with less possibility of adverse effects than oral NSAIDs, while capsaicin-based products have also shown to be effective, but generally need to be used for a few weeks before showing a significant benefit.

Glucosamine
The use of glucosamine, with or without chondroitin, remains a popular alternative therapy in Australia. A 2005 Cochrane review of glucosamine determined that although glucosamine is unlikely to be significantly better than a placebo, it may still reduce pain or improve physical function4. Patients with coagulation disorders or shellfish allergies should avoid glucosamine, however glucosamine is otherwise well tolerated, making it an alternative option for many patients.

Anti-inflammatories
Arthritis is most prominent in elderly patients who are also more likely to suffer from blood pressure, renal or cardiovascular problems. Since most anti-inflammatory medications can have a negative impact on these conditions, their use should be carefully considered and limited if possible. Short-term use may be warranted for more severe, acute pain in patients where NSAIDs are appropriate – often in combination with paracetamol.

Written by Nate Hentschel

1. Australian Institute of Health and Welfare: Arthritis, osteoporosis and other musculoskeletal conditions.
2. Lynch A, Dunican K, Seed S. Osteoarthritis: A review of treatment options. Formulary, 2009;44:143-151.
3. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C. Knee osteoarthritis and obesity. International Journal of Obesity, 2001, 25(5):622-627.
4. Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt J, Welch V, Hochberg MC, Wells GA. Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2005, Issue