Management of the At-Risk Patient with Osteoarthritis

Alan D. Bell, MD, Department of Family and Community Medicine, Humber River Regional Hospital, Toronto, ON.

Douglas C. Conaway, MD, Section of Rheumatology, Carolina Health Specialists, Myrtle Beach, SC, USA.

Recent disclosures of cardiovascular safety issues with medications that have become mainstays of osteoarthritis management have compelled clinicians to reconsider treatment approaches. This new information must be taken into account along with the well-known risk of gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs. Consequently, clinical management of osteoarthritis pain in older patients requires careful evaluation and consideration of the individual patient’s risk factors. Co-therapy with proton pump inhibitors has demonstrated reductions in endoscopic gastropathy, but clinical outcome trials are lacking. For all treatment decisions, monitoring of patients’ responses to therapy is crucial for optimizing long-term safety and efficacy outcomes.

Key words: osteoarthritis, drug therapy, nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2 inhibitors.