New horizons and perspectives in the treatment of osteoarthritis

Abstract

Osteoarthritis (OA) is increasingly prevalent worldwide and is associated with a significant economic burden. Despite the increasing number of patients with OA, treatments to manage the condition remain symptomatic, designed to control pain, and improve function and quality of life while limiting adverse events. Both the EULAR (European League Against Rheumatism) and the OARSI (Osteoarthritis Research Society International) issued new guidelines in 2007 and 2008 recommending a combination of nonpharmacological and pharmacological modalities to manage OA effectively. Because of gastrointestinal risks (including ulcer complications) and cardiovascular risks (including hypertension and thrombotic events associated with nonsteroidal anti-inflammatory drugs [NSAIDs]), these guidelines propose acetaminophen as the first choice anti-inflammatory agents. However, NSAIDs are considered to be more effective than acetaminophen for relief of pain. Given the efficacy, safety, and tolerability issues associated with NSAIDs, development of new agents to manage the pain associated with arthritis but without the cardiovascular and gastrointestinal adverse events remains a priority. This review considers current recommendations for the treatment of OA, the most recent evidence on the cardiovascular risks associated with current NSAID treatments, and the potential of newer anti-inflammatory agents with improved benefit-risk profiles.

Figure 1

Therapeutic potential of exogenous nitric oxide (NO) in NSAID-induced gastric damage. Presented is a diagram of the pathogenesis of NSAID-induced gastric mucosal injury and the possible steps at which exogenous NO could help to protect against NSAID-induced gastric damage. Reproduced with permission from Wallace [53]. COX, cyclo-oxygenase; NSAID, nonsteroidal anti-inflammatory drug.