Key concepts

© Osteoarthritis (OA) is the most common form of arthritis and is most prevalent in the middle to later years of life.

O1 The most common symptoms are joint pain, reduced range of motion, and brief joint stiffness after periods of inactivity.

Treatment goals are to educate the patient and caregivers, relieve pain, maintain or restore mobility, minimize functional impairment, preserve joint integrity, and improve quality of life.

Nonpharmacologic therapy is the cornerstone of treatment; education, exercise, weight loss, and cognitive behavioral intervention are integral components.

Acetaminophen is the initial drug of choice; an adequate dose and duration of therapy should be used before resorting to other drug classes.

© Nonsteroidal anti-inflammatory drugs (NSAIDs) may be initiated if acetaminophen therapy fails. At equipotent doses, all NSAIDs elicit similar analgesic and anti-inflammatory responses. Selection is based on patient preference, dosing frequency, tolerability, and cost.

Patients who do not respond adequately to one NSAID may respond to a different NSAID.

© NSAIDs are associated with GI, renal, hepatic, and CNS toxicity and may increase blood pressure.

O NSAIDs that are selective for the cyclooxygenase-2 (COX-2) isozyme are less likely to cause GI complications but may increase the risk of cardiovascular events. They are no more effective than nonselective NSAIDs and should be reserved for patients at high risk of GI complications and low risk for cardiovascular events.

© Glucosamine, tramadol, opioids, topical capsaicin, topical NSAIDs, intra-articular corticosteroids, hyaluronic acid, and surgery may be beneficial in certain situations.

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