Table 1 Current traditional pharmacological therapies for osteoarthritis

Non-steroidal anti-inflammatory drugs (NSAIDs)

Analgesic effects; reduction in pain, stiffness, swelling

Often inadequate symptom relief; potential for liver damage in overdose; potential for ulcer and kidney disease; potential for bleeding and vascular events; can cause allergies; effectiveness is dependent upon patient compliance; will not reverse cartilage damage

[4–8]

Physical activity/therapy

Can improve flexibility, range of motion, and function of joint; can provide pain relief; strengthens muscles around the joint; targets obesity, the most important modifiable risk factor for OA

Often poor patient compliance; pain/symptom relief is often not enough for patient to adhere to the regiment; will not reverse cartilage damage

[9–12]

Opioids

Provide pain relief

Usefulness in the long-term is limited; Increased risk of adverse events (fractures, cardiovascular events, depression, addiction, overdose, mortality); numerous side effects; will not reverse cartilage damage

[9, 13–15]

Intra-articular injections

Hyaluronic acid injections can provide pain relief and improved function that can last over 8 weeks; corticosteroid injections can provide effective short-term pain relief and improved function

Injections must be performed in a doctor’s office; injections done more than once every 4 months can result in cartilage and joint damage and increase the risk of infection; hyaluronic acid injections show varying efficacy; neither type of injections will reverse cartilage damage

[9, 15–17]

Surgery

Total joint arthroplasty can potentially provide permanent pain relief and improved mobility; arthroscopic irrigation and debridement can offer pain relief

Many joints do not respond well to total joint arthroplasty; surgery is expensive for patients; increased risk of infection and invasive trauma; arthroscopic procedures do not provide long-term benefits

[9, 15, 17, 18]