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Matters arising
Guidelines for the treatment of osteoarthritis
  1. D E Furst1,
  2. J R Caldwell2
  1. 1Director of Arthritis Clinical Research, Virgina Mason Research Center, Seattle, Washington, USA
  2. 2Florida Arthritis and Allergy Institute, Daytona Beach, Florida, USA

    https://doi.org/10.1136/ard.61.5.476

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      Guidelines for the treatment of osteoarthritis (OA) have several purposes, but a major one relates to its use by regulatory or medical insurance agencies that use it to help guide their response to requests for drugs to treat patients.

      Data have recently been published which record the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) over paracetamol (acetaminophen) and report patients' preferences for NSAIDs rather than paracetamol in the treatment of OA.1–7 Furthermore, inflammation is a common accompaniment of moderate to severe OA.8–10 Therefore it would seem appropriate to consider the use of NSAIDs as the primary treatment in the group of patients with OA with moderate to severe pain or inflammation as part of their disease.

      The EULAR Guidelines state that paracetamol is the first line of treatment for all patients with OA,11 despite the recent evidence that NSAIDs are more efficacious than paracetamol and that paracetamol is associated with more gastrointestinal toxicity than was previously thought.12

      Would it …

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