■ Educate patients about OA and management (Zhang et al., 2008)
The OARSI Guidelines also recommend both nonpharmaco-logic and pharmacologic interventions. OARSI pharmacologic recommendations include the following:
■ Acetaminophen as first-line treatment: limit to 4 grams per day and reduce amount in patients with hepatic or renal disease or alcoholic patients.
■ NSAIDs provide better relief than acetaminophen but have significant, life-threatening, serious adverse effects. Long-term use should be avoided. See information in Section 2, Chapter 3 on risk benefits of NSAID use.
■ Topical medications, such as capsaicin, and topical NSAIDs, such as diclofenac, may also have risk-benefit recommendations related to side effect profile.
■ Trial opioid therapy when other agents are ineffective or contraindi-cated. The American Geriatrics Society endorses the use of opioids in older patients when severe pain, pain-related functional impairments, or decreased quality of life is due to pain (see Section 2, Chapter 4 for choices of opioids).
■ Glucosamine or chondroitin sulfate may provide some symptomatic relief.
■ Intra-articular injections may provide relief.
OARSI nonpharmacologic recommendations include the following:
■ Patient education on osteoarthritis and self-management
■ Physical therapy to decrease pain and improve function
■ Aerobic activity to maintain muscle strength, such as water aerobics
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