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Practical Management of OsteoarthritisIntegration of Pharmacologic and Nonpharmacologic Measures
Marie R. Griffin, MD, MPH;
Kenneth D. Brandt, MD;
Matthew H. Liang, MD, MPH;
Theodore Pincus, MD;
Wayne A. Ray, PhD
Arch Fam Med. 1995;4(12):1049-1055.
Abstract
Pharmacotherapy should play an adjunctive role to nonpharmocologic 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.
Author Affiliations
From the Departments of Preventive Medicine (Drs Griffin and Ray) and Medicine (Drs Griffin and Pincus), Vanderbilt University School of Medicine, Nashville, Tenn; Division of Rheumatology, Indiana University School of Medicine, Indianapolis (Dr Brandt); and Department of Rheumatology and Immunology, Harvard Medical School, Boston, Mass (Dr Liang).
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