Pathophysiology and first-line treatment of osteoarthritis.
OBJECTIVE
To review the pathophysiology of osteoarthritis (OA) and the various treatment modalities, focusing specifically on acetaminophen (APAP), nonsteroidal antiinflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors as the primary treatment options.


METHODS
Primary literature and tertiary references were identified by a MEDLINE search (1966-March 2001) and through other secondary sources.


METHODS
After evaluating the articles and references identified from the data sources, all the information that was judged relevant by the reviewers was included in the review article.


RESULTS
OA is the most common joint disorder worldwide. Current research suggests that factors such as inflammation and changes in subchondral bone may play a larger role in the pathophysiology than previously thought. With this research and the development of COX-2 inhibitors, selecting the medication of choice for OA has become difficult.


CONCLUSIONS
More research needs to be done before the pathophysiology of OA can be clearly determined. In the meantime, treatment should be based on clinical data and patient response. Studies have shown that APAP and NSAIDs have comparable efficacy, as do traditional NSAIDs and COX-2 inhibitors. APAP is associated with fewer toxicities than are the traditional NSAIDs. Due to their mechanism of action, the new COX-2 inhibitors should result in fewer adverse effects compared with traditional NSAIDs, but evidence from clinical trials has not been conclusive. Therefore, APAP should still be considered the drug of choice for OA.
Hogue
Jesse H
JH
Bronson Methodist Hospital, Kalamazoo, MI, USA.
Mersfelder
Tracey L
TL
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D016239:MEDLINE; D008297:Male; D008565:Membrane Proteins; D010003:Osteoarthritis / Q000188:drug therapy* / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*; D011451:Prostaglandin-Endoperoxide Synthases; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases