NSAID Therapy for Hand Osteoarthritis

Introduction to NSAID Use

The European League Against Rheumatism recommends that oral NSAIDs should be reserved for patients who fail paracetamol and topical NSAIDs, used at the lowest effective dose for the shortest duration possible, with mandatory cardiovascular and gastrointestinal risk stratification before prescribing 1

Topical NSAIDs are preferred over oral NSAIDs for hand OA, particularly when mild to moderate pain affects only a few joints, as recommended by the European League Against Rheumatism 1, 2
The European League Against Rheumatism suggests prescribing oral NSAIDs only when patients respond inadequately to paracetamol and topical NSAIDs 1, 2
The European League Against Rheumatism recommends using the lowest effective dose for the shortest duration necessary 1, 2

For patients with increased gastrointestinal risk, the European League Against Rheumatism recommends prescribing non-selective NSAIDs plus a gastroprotective agent or a selective COX-2 inhibitor 1
For patients with increased cardiovascular risk, the European League Against Rheumatism recommends that COX-2 inhibitors are contraindicated and non-selective NSAIDs should be used with extreme caution 1

The European League Against Rheumatism advises against prescribing oral NSAIDs as first-line therapy when topical options have not been tried, especially in elderly patients or those with multiple comorbidities 1
The European League Against Rheumatism recommends assessing cardiovascular and gastrointestinal risk factors before initiating any oral NSAID therapy 1
The European League Against Rheumatism suggests not continuing oral NSAIDs indefinitely without periodic reassessment of efficacy, necessity, and emerging risk factors 1
The European League Against Rheumatism recommends trying paracetamol before any NSAID given its first-line status and safety profile 1, 2