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Managing Osteoarthritis-associated Pain
Declaration of sponsorship Pfizer and Lilly

Clinical guidelines

Declaration of sponsorship Pfizer and Lilly
Read time: 50 mins
Last updated:10th Nov 2020
Published:10th Nov 2020
Clinical osteoarthritis (OA) treatment guidelines from three major scientific bodies have been updated in the last year (ACR, ESCEO and OARSI). While non-steroidal anti-inflammatory drug (NSAID) treatment remains strongly recommended the use of paracetamol and opioids have been downgraded due to lack of efficacy and risk of adverse events. Updated guidelines also focus on the need for consideration of patient comorbidities and risk factors in order to personalise treatment.

A number of clinical guidelines for treating OA-associated pain are available

Guideline updates over the last year have downgraded the use of paracetamol and opioids for OA-associated pain and highlighted the importance of individual patient management. 

Find out the key points of the updated treatment guidelines in the following infographic.

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NSAIDs

“all NSAIDs should be used at the lowest effective dose for the shortest period of time necessary to control pain, i.e. intermittently or in longer cycles rather than in chronic use”2.

i.e. intermittently or in longer cycles rather than in chronic use”2.

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The use of paracetamol has been downgraded in recent pain management guidelines

 

“When analgesic benefit is uncertain and with increasing safety issues, more careful consideration of paracetamol use is required”11

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The use of opioids has been downgraded in recent pain management guidelines

“Use of the lowest possible doses for the shortest possible length of time is prudent”3

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Common OA comorbidities

The prevalence of comorbidities among patients with OA is high. In a large retrospective cohort study in Canada (n = 207,610 patients), 67 % of those with OA (14% of study population) had at least one comorbidity (after adjustment for age and sex) which included21:

  • hypertension (prevalence ratio [PR] 1.17, 95% confidence interval 1.15–1.19)
  • depression (PR 1.26, 95% confidence interval 1.22–1.30)
  • chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% confidence interval 1.11–1.21)
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Pharmacologic treatment options

  • Marie was initially started on 325 mg of paracetamol four times a day, dose was increased to 1 g four times a day after two weeks but it still did not alleviate her pain.

Guidelines no longer recommend regular paracetamol due to a minimal effect on pain and increasing evidence of gastrointestinal, cardiovascular and renal adverse events (AE), along with increased mortality risk11.

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