Osteoarthritis: a guide to management in adults

A 60 year old woman has bad osteoarthritis in her ankle.

The pain doesn’t respond to paracetamol or topical NSAIDs so you decide to change the medication regime. Which of the following is correct?

		Pre-test answer	Your answer	Correct answer
a.	Substitution with an oral NSAID/COX-2 inhibitor should not be considered
b.	The addition of an oral NSAID/COX-2 inhibitor to paracetamol should not be considered
c.	Use oral NSAIDs/COX-2 inhibitors at the lowest effective dose for the shortest possible period of time
d.	When prescribing these drugs, consideration should not be given to appropriate assessment and/or ongoing monitoring of these risk factors

That's right.

Where paracetamol or topical NSAIDs are ineffective for pain relief for people with osteoarthritis, then substitution with an oral NSAID/COX-2 inhibitor should be considered.

Where paracetamol or topical NSAIDs provide insufficient pain relief for people with osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be considered.

Oral NSAIDs/COX-2 inhibitors should be used at the lowest effective dose for the shortest possible period of time.

All oral NSAIDs/COX-2 inhibitors have analgesic effects of a similar magnitude but vary in their potential gastrointestinal, liver and cardio-renal toxicity; therefore, when choosing the agent and dose, take into account individual patient risk factors, including age. When prescribing these drugs, consideration should be given to appropriate assessment and/or ongoing monitoring of these risk factors.