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Drug treatment of osteoarthritis
Last reviewed: 08.07.2025
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All drugs used for osteoarthritis are conventionally divided into two groups:
- symptomatic (symptoms modifying antiosteoarthritis drugs - SMOADs),
- pathogenetic, or disease modifying (structure modifying or disease modifying antiosteoarthritis drugs - DMOADs).
A distinction is also made between slow-acting and fast-acting drugs.
The conventionality of such division is due to the lack of knowledge about the mechanisms of action of drugs used in osteoarthrosis. Almost all drugs used in the treatment of patients with osteoarthrosis (NSAIDs, depot GCS, hyaluronic acid, chondroitin sulfate, etc.) have a symptomatic effect, but differ in the speed of onset of the effect - fast-acting symptomatic agents include non-narcotic analgesics, NSAIDs, depot GCS and others, and slow-acting ones include hyaluronic acid, chondroitin sulfate, etc.
Since pathogenetic properties have not been proven for any therapeutic agent at present, drugs that are often called "disease-modifying" or "structure-modifying" (hyaluronic acid, chondroitin, glucosamine sulfate, etc.) cannot be classified in this group. However, this does not mean that the listed drugs, as well as other drugs (e.g., NSAIDs), do not have such properties. At the same time, the effect of such drugs cannot be reduced exclusively to a symptomatic effect - their ability to favorably influence the metabolism of articular cartilage in patients with osteoarthritis has been demonstrated in vivo and in vitro.
It is important to remember that symptomatic drugs can have a pathogenetic effect and, conversely, drugs with a pathogenetic effect can have a symptomatic effect.
Thus, the modern classification of therapeutic agents for osteoarthritis can be presented as follows.
Classification of drugs used in osteoarthritis developed by the Joint WHO/ILAR Committee
1. Symptom-modifying antiosteoarthritis drugs (SMOADs):
- fast acting
- slow-acting (symptomatic slow-acting drugs for osteoarthritis - SYSADOA)
2. Disease modifying antiosteoarthritis drugs (DMOADs)
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