Prescribing for Osteoarthritis

NSAIDs are generally used to manage pain associated with osteoarthritis. However, because of the risks associated with NSAIDs (renal/gastric complications, dyspepsia, VTE) this will not be suitable for all patients. NSAIDs can be taken orally but also topically, which may be an option for some.

Paracetamol may be used in palce of NSAIDs, but prolonged use at the maximum dose may cause gastro intestinal problems so this needs to be considered.

Opioids have not been proven to be hugely effective in osteoarthritic pain, and prolonged use can lead to dependence and increased tolerance even when a lower dose is combined with paracetamol. It also has the potential side effects of nausea and constipation.

This leaves steroid injections; these are effective for up to 3 months but are not suitable for diabetes due to their ability to destabilise blood glucose.

The holistic approach is essential, and lifestyle counselling may be required if a patient is inactive and/or overweight.

Physiotherapy may be beneficial as may acupuncture (although its efficacy has not been proven sufficiently through clinical trials).

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