Osteoarthritis Treatment Guidelines

Introduction to Osteoarthritis Management

The British Medical Journal recommends exercise and physical activity focusing on local muscle strengthening and general aerobic fitness as a first-line treatment for osteoarthritis 1, 2, 3
Weight loss interventions are recommended for overweight or obese patients with osteoarthritis 1, 2
Education about the condition and self-management strategies is also a first-line treatment for osteoarthritis 2

Paracetamol (acetaminophen) is recommended as a second-line pharmacological treatment for osteoarthritis, with regular dosing as needed 1, 2, 4
Topical NSAIDs are recommended for knee and hand osteoarthritis 1, 2
Oral NSAIDs/COX-2 inhibitors, such as etoricoxib, are recommended when paracetamol or topical NSAIDs are insufficient 1, 2, 5
The British Medical Journal recommends prescribing oral NSAIDs/COX-2 inhibitors with a proton pump inhibitor for gastroprotection 1, 5

Etoricoxib has a better gastrointestinal safety profile than non-selective NSAIDs 6
The Annals of the Rheumatic Diseases notes that all COX-2 inhibitors and NSAIDs carry cardiovascular risk that must be evaluated 7
Etoricoxib should be used at the lowest effective dose (60mg for OA) for the shortest possible duration 1, 2

The British Medical Journal recommends evaluating gastrointestinal risk factors before prescribing NSAIDs/COX-2 inhibitors 1, 5
The Annals of the Rheumatic Diseases suggests assessing cardiovascular risk factors, particularly uncontrolled hypertension, before prescribing NSAIDs/COX-2 inhibitors 7
Renal function, especially in elderly patients, and hepatic function should be considered before prescribing NSAIDs/COX-2 inhibitors 1, 2, 5
Regular assessment of pain relief and functional improvement is recommended during treatment with NSAIDs/COX-2 inhibitors 1, 2