Pharmacologic therapy for osteoarthritis.

Osteoarthritis is treated with a variety of pharmacologic therapies, including acetaminophen, traditional nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2 inhibitors, intra-articular steroids, viscosupplements, glucosamine, chondroitin sulfate, capsaicin, and vitamins. In this review, we describe the clinical efficacy and side effects of these pharmaceuticals. Except for vitamins, each of these therapies is effective over the short-term when compared with placebo in controlled clinical trials. Risk-benefit analysis should be considered when prescribing these medications, as side effects are relatively common, and long-term efficacy is variable. In this review, we also examine current and future research on new medications--particularly matrix metalloproteinases and inducible nitric oxide synthase inhibitors--that may modify osteoarthritis.