Treatment Of Osteoarthritis In Elderly Patients

The preferred initial therapy for elderly patients with arthralgia due to osteoarthritis is which of
the following?

A) NSAIDs.
B) COX-2 inhibitors.
C) Acetaminophen.
D) Combination narcotic analgesics.
E) Early joint replacement.

Answer:

The correct answer is “C.” Acetaminophen

Discussion: Because of greater risk of gastrointestinal (GI) and renal toxicity in the elderly, NSAIDs should be avoided if possible and limited if used in this population. As for COX-2 inhibitors, the advantage in GI side effects is questionable, and the cost is much greater than traditional NSAIDs.
The best initial choice for osteoarthritis pain in the elderly (and almost everybody, for that matter) is acetaminophen with doses scheduled three to four times per day. In older patients, do not exceed 3 g of acetaminophen per day.
Combination narcotic analgesics are employed when acetaminophen alone does not suffice and NSAIDs are contraindicated. Although elderly patients should be considered candidates for joint replacement, it is not appropriate as the initial therapy.
Other treatments of osteoarthritis that have some demonstrated benefit for short-term pain control include topical capsaicin cream, topical NSAIDs, intra-articular steroid injection, and intra-articular hyaluronic acid injection. A single, high volume, injection of the latter has been approved by the FDA for treatment of primary osteoarthritis of the knee.
Glucosamine, with or without chondroitin, has not shown benefit in rigorous trials. None of these treatments has demonstrated clinically significant, long-term benefit.