Download Pharmacological Management of Knee and Hand Osteoarthritis in Adults: A Guideline and more Lecture notes Pharmacology in PDF only on Docsity! Guideline 819FM.3 1 of 2 Uncontrolled if printed 819FM.3 PHARMACOLOGICAL MANAGEMENT OF KNEE AND HAND OSTEOARTHRITIS IN ADULTS Target Audience: Primary and Secondary Care Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide. Osteoarthritis is characterised pathologically by localised loss of cartilage, remodelling of adjacent bone and associated inflammation. In addition to holistic and non-pharmacological management, pharmacological management should be offered. All drugs need a trial of 2 - 4 weeks unless there is intolerance. Aim to use the lowest effective dose for the shortest time possible. Do not prescribe rubefacients. Step 1: Paracetamol 1 g orally four times a day regularly Step 2: Add topical non-steroidal anti-inflammatory drugs (NSAIDS) • Ibuprofen gel 5% or 10%, applied up to three times a day • Diclofenac 1.16% gel applied up to four times a day • Piroxicam 0.5% gel applied up to four times a day NB. Other than ibuprofen 10% gel, these are available over the counter. Topical application in large amounts can result in systemic side effects and the possibility of drug interactions. Step 3: Consider adding oral NSAID or selective COX-2 inhibitor, and stop topical NSAID. The choice of drug will depend on individual patient risk factors (Refer to BNF, NICE CKS NSAIDs-prescribing issues or Buckinghamshire Healthcare NHS Trust (BHT) Guideline 299FM Prescribing Non-steroidal Anti-inflammatory Drugs (NSAIDs) in Adults). Absolute contraindications include allergic reaction, gastrointestinal (GI) bleeding/ulceration, severe heart failure, severe hepatic impairment or severe renal impairment with estimated glomerular filtration rate (eGFR) <30 mL/minute/1.73 m2). Drugs to consider • Ibuprofen 400 mg three times a day - usually used first line due to more favourable adverse event profile. (NB. Higher doses up to 2.4 g per day can be used if no cardiovascular risk factors.) • Naproxen 250 – 500 mg twice a day (AVOID if gastrointestinal bleed risk factors). • Diclofenac 25 – 50 mg three times a day (AVOID if cardiovascular disease risk factors). • COX-2 inhibitors (celecoxib 200 mg daily increased up to 200 mg twice daily or etoricoxib 30 mg once a day). Lower risk of serious GI bleeding than with the above non-selective NSAIDs, but avoid if cardiovascular disease risk factors. NSAIDs/COX-2 inhibitors should be co-prescribed with a proton pump inhibitor (PPI) (e.g. lansoprazole 15 – 30 mg OD or omeprazole 20 - 40 mg OD). Ensure higher dose if on oral anticoagulants or any increased risk of a GI bleed. If on low-dose aspirin, consider other analgesics (see step 4) before using an NSAID or COX-2 inhibitor due to increased GI bleeding risk. Frequent review and monitoring for adverse effects is required.
