Arthritis pain? The Best Meds for Relief Are…

Arthritis pain? The Best Meds for Relief Are…

What all osteoarthritis and arthritis sufferers know is that this condition can severely affect your ability to lead an active life. Its trademarks are stiff and swollen joints, and lots of limiting pain.

Standard treatments for relief of pain and stiffness call for cortisol injections, non-steroidal anti-inflammatory drugs (NSAIDs), chondroitin, glucosamine, and other options like biologics. When you’re suffering, all you want to know is this –

Which drugs are most effective for relieving arthritis pain?

A recent study compared the clinical impact of over 30 medications used for arthritis pain management. More than 22,000 individuals were tracked over a full year in 42 separate trials, testing both drug effectiveness and drug safety.

To assess patient pain and joint functionality levels throughout the study, two measurements were used:

  1. WOMAC scale – a widely recognized standardized method of evaluating arthritis-related pain, stiffness and joint function
  2. VAS score – a visual analog scale patients use to assign a pain score from zero to 10

Here are the conclusive results of the study.

Non-steroidal anti-inflammatory drugs (NSAIDs) 

NSAIDs are the most widely used medications for osteoarthritis. They’re the anti-inflammatories you recognize as aspirin, ibuprofen (Advil, Motrin, Midol), and naproxen (Aleve, Naprosyn).

Of all the available NSAIDs, celecoxib (known as Celebrex) was the only one to show some reduction in pain scores. A measurement of −0.18 SMD (standard mean difference) was reported; a rather small improvement. Celecoxib did help with pain management, but did not improve physical joint function.

Here’s the science behind the medication:

Celecoxib is a potent COX-2 inhibitor, targeting the enzymes directly responsible for inflammation and pain. It is preferred over COX-1 and COX-2 because it’s less likely to affect the stomach enzyme epithelia, and poses less cardiovascular risk. However, long term use of celecoxib is still associated with an increased risk of bleeding, particularly in people with a reduced celecoxib clearance by the CYP2C9 enzyme.

Note: The FDA placed a warning label advising against long term use of celecoxib in juvenile arthritis patients who are poor CYP2C9 metabolizers.

[To find out if your child is a poor CYP2C9 metabolizer, order the Pillcheck test kit.]

NSAIDs are only recommended for short-term or intermittent use due to increased risk of GI bleeding and cardiovascular events.

Glucosamine Sulfate

Glucosamine sulfate, a chemical found naturally in the human body, is involved in building tendons, ligaments, cartilage, and the thick fluid that surrounds joints.

Patients taking glucosamine sulfate had larger reduction in pain scores (−0.29 SMD).

Glucosamine sulfate consistently improved pain levels, physical function, and joint structure – while other glucosamines were not associated with clinical benefit. Glucosamine sulfate must be taken daily to provide ongoing benefit, and proved to have the highest probability of being the safest long-term treatment.

More good news: Analysis of the study showed, for the first time, that the protective effect of glucosamine for arthritis pain, function, and joint structure, is more robust than other treatment options such as diclofenac, rofecoxib, and chondroitin sulfate.

What’s more, glucosamine sulfate showed significant improvement in physical function – and when combined with celecoxib glucosamine, had an even greater impact on reducing chronic pain.  

Hyaluronic Acid and Corticosteroid Injections

Corticosteroid injections directly into the joints resulted in greater pain relief during the first few weeks of treatment, while injections of hyaluronic acid were associated with greater benefit at three and 6-months following the procedure. However, test results show no association of hyaluronic acid with long-term arthritis pain improvement.

Injections using a combination of both hyaluronic acid and corticosteroids had highly variable results.

Other drugs & treatments

In all, 16 drugs and interventions were assessed for structural joint changes.

Chondroitin sulfate, strontium ranelate, and glucosamine sulfate were significantly associated with improvement in joint structure. Chondroitin sulfate had no impact on pain and function, thus the long-term use of chondroitin sulfate and strontium might not provide meaningful improvement.

Strontium ranelate (Protelos), a drug approved for the treatment of osteoporosis in Europe, was also tested. It is not available in Canada due to cardiovascular safety concerns.

Recap of the study findings:

  1. Glucosamine sulfate consistently improved pain levels, physical function, and joint structure
  2. Glucosamine sulfate should be taken daily for maximum benefit
  3. Celecoxib alleviated some pain – but did not improve joint function
  4. Glucosamine sulfate and celecoxib combined are a more potent pain fighter
  5. About 20% of people have reduced CYP2C9 function and should use lower doses of celecoxib
  6. Up to 5% of people are poor CYP2C9 metabolizers and should avoid long-term use of NSAIDs
  7. Corticosteroid injections helped pain relief in the short term
  8. Hyaluronic acid injections showed better longer-term relief (3-6 months)
  9. Chondroitin sulfate had no impact on pain and function but did improve joint structure
  10. NSAIDs are recommended for short-term pain relief and intermittent use only

Conclusion

This comprehensive study of arthritis pain medications showed that only celecoxib (Celebrex) and glucosamine sulfate have proven helpful – particularly when used together. Most other drugs, supplements, and even intra-joint injections, are found to be largely ineffective in controlling arthritis pain.

If you are suffering from chronic arthritis pain, consider Pillcheck to assess whether celecoxib is safe for you. Pillcheck also provides insights on other painkillers including opioids (oxycodone, tramadol, codeine, morphine) and NSAIDs (celecoxib, diclofenac, flurbiprofen, meloxicam, piroxicam) that can be used to manage arthritis pain.

Selected references:

Gregori D., et al. Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis JAMA. 2018 Dec 25;320(24):2564-2579.

FDA: Table of Pharmacogenomic Biomarkers in Drug Labeling

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