Arthritis Management
Pharmacological Treatment
Pain management is an important feature of any arthritis treatment.
These recommendations are presented in abbreviated form. Readers should refer to the text of the EULAR Guideline document1 for a detailed discussion of each of the following topics.
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Paracetamol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic. Paracetamol is frequently used as self medication for the treatment of mild to moderate pain.
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NSAIDs should be considered in patients unresponsive to paracetamol. In patients with an increased gastrointestinal risk, non-selective NSAIDs and effective gastroprotective agents, or selective COX 2 inhibitors should be used.
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Opioid analgesics, with or without paracetamol, are useful alternatives in patients in whom NSAIDs, including COX 2 selective inhibitors, are contraindicated, ineffective, and/or poorly tolerated.
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SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, and hyaluronic acid) have symptomatic effects and may modify structure.
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Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion.
When considering any treatment, all the risks and benefits must be evaluated on an individual patient basis. GI and CV profiles must be assesed.
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Reference:
1. Jordan K M, Arden N K, Doherty M, Bannwarth B, et al.: EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62;1145-1155. doi:10.1136/ard.2003.011742.