Osteoarthritis requires treatment vigilance – from medication to exercise – that, at times, can be taxing. But research shows that adherence to your treatment regimen can keep pain and disability at bay.

“If you don’t [comply with treatment], symptoms return,” says gastroenterologist Byron Cryer, MD, associate dean and professor of medicine at University of Texas Southwestern Medical School in Dallas. “In patients with OA, the principle issues are lack of mobility and quality of life.  If you improve adherence, you improve both.”

Taking the Meds You Need

In a 2012 study of 162 patients primarily with knee or hip osteoarthritis at Tufts Medical Center in Boston, researchers found that 37 percent were taking multiple medications on the same day, and 15 percent were using multiple medications plus supplements. Of those taking multiple medications, 40 percent used prescription and over-the-counter medicines.  Twenty-eight percent found treatment ineffective or sought stronger medications. Those who found medications ineffective were more apt to quit taking them after only two weeks.

“We were concerned that patients were taking multiple nonsteroidal anti-inflammatory drugs (NSAIDs) … [risking] increasing side effects like gastrointestinal distress,” says Jeffrey B. Driban, PhD, assistant professor of rheumatology, Tufts Medical Center.

Driban was also concerned that patients were seeking their own ways of managing symptoms because they didn’t feel prescribed medications were adequate.  In some cases, patients were taking friends’ medications. Other patients stopped taking prescribed medications as soon as the first prescription ran out.

“We worried that patients were increasing risks of side effects and increasing costs by taking multiple medications,” says Driban.

A 2011 study at UT Southwestern Medical School studied patients with GERD (gastroesophageal reflux disease) and osteoarthritis or rheumatoid arthritis. The patient information came from 543 patients who took celecoxib (Celebrex), a COX-2 inhibitor, and 2,118 who took NSAIDs, which, inhibit both COX-1 and COX-2 enzymes, resulting in gastric irritation. Celecoxib inhibits only COX-2, making it easier on the stomach.

After two years, 80 percent of patients were still taking celecoxib; only 60 percent were still taking non-select NSAIDs.  The reason? People taking celecoxib had fewer symptoms of GERD, says Dr. Cryer, and their stomachs suffered less.

So, what’s to be gleaned from such studies? How can you take meds as prescribed with effectiveness and few side effects?

  • Talk to your doctor more, not less. “If you feel like your medication isn’t working after a few days,” says Driban, “rather than stopping, tell your physician and ask for [alternatives].”

    The same goes for side effects: Tell your doctor about them. “Gastrointestinal symptoms are a very common reason for discontinuing OA medications,” says Dr. Cryer. “Ask your provider if he can switch your medication or give you an additional medication to improve symptoms.”

    In some cases you can take a proton pump inhibitor (a prescription antacid) with an NSAID, or use a different pain reliever to reduce gastrointestinal symptoms, says Driban.

    “Ask about pros and cons of treatments,” says Driban. ‘‘And ask what over-the-counter medications will help you avoid problems. Sometimes, it’s a matter of [taking] a smaller dose.”