Acetaminophen or NSAIDs for the treatment of osteoarthritis

Although non-pharmacological interventions are the cornerstone of osteoarthritis management, analgesics are an important component of treatment during the symptomatic periods of the disease. In this respect, current practice guidelines advocate the use of a simple analgesic, acetaminophen, or a non-steroidal anti-inflammatory drug (NSAID), given either systemically or topically as first-line or second-line drug therapies. The present paper aims first to assess the evidence for the efficacy and safety of these medications. Given the increasing importance of patient involvement in decision-making, the following key practical issue regarding acetaminophen and NSAIDs will then be addressed: 'which drug do patients prefer?' Regarding NSAIDs, a further question concerns the place for non-selective agents and cyclo-oxygenase-2 (COX-2) selective inhibitors (coxibs) in the light of new warnings and contraindications concerning coxibs in patients with increased risk of cardiovascular thrombotic events.