How to initiate and advance medical treatment in a typical patient with Osteoarthritis?
No medication or intervention has been shown yet to stop or reverse the disease process underlying OA. Medications are used, therefore, to alleviate symptoms and increase function with the least toxicity. A reasonable approach to therapy is to start with acetaminophen 650 mg every 6 to 8 hours as needed (maximum total dose ≤3–4 g/day), which can decrease OA pain by approximately 30%. If unsuccessful, nonsteroidal antiinflammatory drugs (NSAIDs) can be used; these may be more effective in treating localized inflammation than acetaminophen. In these patients, using the smallest effective dose and/or intermittent dosing is prudent if possible. Use of COX-2 inhibitors or addition of proton-pump inhibitors may help protect against gastrointestinal adverse effects. In patients who are considered high-risk for oral NSAID use, topical NSAIDs , tramadol , or duloxetine may be effective. Notably, there is no role for oral corticosteroids. However, in a single joint with an inflammatory component, intraarticular corticosteroids
