Osteoarthritis is common, has considerable health consequences, and will affect increasing numbers of persons in coming years. Nonpharmacological interventions are of paramount importance in achieving adequate symptom control. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) play a pivotal role in osteoarthritis pharmacotherapy. Acetaminophen, due to its safety profile, should be adequately trialed before resorting to NSAIDs. NSAIDs and celecoxib, a selective inhibitor of cyclooxygenase-2, should be selected thoughtfully so as to balance the likelihood of treatment success with gastrointestinal bleeding and cardiovascular events. Celecoxib may be used when the risk for gastrointestinal bleeding is high and the risk of cardiovascular events low. Otherwise, NSAIDs, usually naproxen, should be paired with a gastroprotective agent. Topical NSAIDs, including a recently approved diclofenac patch and gel, may also be useful when systemic exposure is undesirable. The role of glucosamine and chondroitin is controversial and the data conflicting. Other modalities, such as tramadol, opioids, and viscosupplementation should be tailored to the patient and clinical situation. Appropriate deployment of agents in the osteoarthritis armamentarium can maximize efficacy and safety thereby improving the disease burden for patients.
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