Practical management of osteoarthritis. Integration of pharmacologic and nonpharmacologic measures
M. R. Griffin, K. D. Brandt, M. H. Liang, T. Pincus and W. A. Ray
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tenn., USA.
Pharmacotherapy should play an adjunctive role to nonpharmacologic measures
in the overall management of patients with symptoms due to osteoarthritis.
Patients should be instructed in how to rest or unload involved joints;
protect them through appropriate manipulation of their environment and
appropriate methods of lifting and bending; and maintain and improve muscle
strength and flexibility to ensure joint stability and prevent
contractures. In most patients, acetaminophen in doses of up to 4 g/d is
preferable to nonsteroidal anti-inflammatory drugs (NSAIDs) as a
first-choice agent because of its lower toxicity. If NSAIDs are used, they
should be prescribed initially in lower (analgesic) doses. Ibuprofen may be
the preferred initial NSAID because it can be given in low doses for short
durations, has been associated with lower rates of gastrointestinal tract
side effects, and is inexpensive.
