Practical management of osteoarthritis. Integration of pharmacologic and nonpharmacologic measures

Pharmacotherapy should play an adjunctive role to nonpharmacologic measures in the overall management of patients with symptoms due to osteoarthritis. Patients should be instructed in how to rest or unload involved joints; protect them through appropriate manipulation of their environment and appropriate methods of lifting and bending; and maintain and improve muscle strength and flexibility to ensure joint stability and prevent contractures. In most patients, acetaminophen in doses of up to 4 g/d is preferable to nonsteroidal anti-inflammatory drugs (NSAIDs) as a first-choice agent because of its lower toxicity. If NSAIDs are used, they should be prescribed initially in lower (analgesic) doses. Ibuprofen may be the preferred initial NSAID because it can be given in low doses for short durations, has been associated with lower rates of gastrointestinal tract side effects, and is inexpensive.