Cortisone is not a good choice in view of its short duration of action and the possibility it can damage cartilage. Now and then in patients whose OA has flared up. In these cases either oral or I.M. cortisone can be helpful when it's important to get the arthritis quickly under control. We also on occasion prescribe it for elderly patients when the damage of OA can only be controlled by low-dose continuous oral steroid. Some patients get very depressed from the daily pain.
Antidepressants seem to ease the pain in soft-tissue rheumatism or fibromyalgia.
We're not sure why this happens. In fact, some patients with fibromyalgia say their OA has decreased while taking antidepressants. For instance, amitriptyline was the standard drug that could be prescribed in low and then increasing doses. Certainly Prozac and the other newer SSRIs have fewer side-effects. We try to prevent a coronary attack by controlling blood cholesterol and hypertension.