Review Question - QID 105970

This patient is suffering from osteoarthritis (OA), a degenerative joint disease for which first line therapy is pain relief with non-steroidal anti-inflammatory drugs (NSAIDs), often in conjunction with a proton pump inhibitor.

OA is a degenerative joint disorder characterized by articular cartilage loss and bone remodeling resulting in joint pain and instability. The disorder is quite common, affecting as many as 25% of adults over the age of 55. Risk factors include age, obesity, prior knee injury (e.g. ACL tear), and a positive family history. The diagnosis is frequently made clinically based on history and physical exam. Radiographs of the affected joint may be obtained to support the diagnosis and gauge severity of disease. Radiographs typically show narrowed joint space with loss of articular cartilage. Acetaminophen was previously preferred over NSAIDs for management of pain associated with OA. However, recent data shows that acetaminophen has a negligible affect on pain as well as risks associated with long-term use. Therefore, NSAIDs are now recommended as first line medical therapy.

Sharma et. al discuss the clinical manifestations, diagnosis and management of osteoarthritis of the knee. They note pertinent risk factors of. They also discuss pharmacologic management options such as NSAID drugs and their associated risks and benefits.

Figure A shows a radiograph of an osteoarthritic knee. Note the significant joint space narrowing and loss of articular cartilage.

Incorrect Answers:
Answer 1: Acetaminophen was previously preferred over NSAIDs for management of pain associated with OA. However, recent data shows that acetaminophen has a negligible affect on pain as well as risks associated with long-term use.

Answer 2: Bed rest is not a recommended strategy in management of OA. On the contrary, daily activity and weight loss have been shown to improve long term outcomes in patients with OA.

Answer 3: Glucosamine and hyaluronic acid supplementation have been found to be ineffective for reducing pain in OA. Studies on the effects on function and quality of life have been inconsistent.

Answer 5: Intraarticular dexamethasone injection is sometimes employed in the management of pain related to OA. However, studies have shown that improvements in pain are often brief without long-term improvement.

Bullet Summary:
Pain due to osteoarthritis should be managed first with acetaminophen due to the renal and gastrointestinal side effects associated with NSAIDs (e.g. ibuprofen).