[Osteoarthritis - which approach is evidence based?].
Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs is slightly higher and they also have some antiphlogistic effect, but their use has to be strictly limited to a short period of time. They should mainly be used in the therapy of the acute and painful phase of osteoarthritis. Among the NSAIDs, Diclofenac is the medication of first choice. In patients with an increased risk of gastrointestinal complications, a protonpumpinhibitor should be added. Patients with cardiovascular risk factors should receive NSAIDs only in case of no appropriate alternative treatments. Opioids have their place in osteoarthritis treatment and should be part of an individualized pain regime, which should also contain a pain diary and proactive monitoring. It is important to emphasize the positive effects of physical activity on the function of the joints as well as the negative effect of overweight and immobility.
Rosemann
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Institut für Hausarztmedizin, Universitätsspital Zürich, Zürich. thomas.rosemann@usz.ch
Huber
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Rosemann
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D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D010003:Osteoarthritis / Q000175:diagnosis / Q000188:drug therapy*
D000700:Analgesics; D000701:Analgesics, Opioid; D000897:Anti-Ulcer Agents; D018501:Antirheumatic Agents; D052246:Cyclooxygenase 2 Inhibitors; D004008:Diclofenac; D000082:Acetaminophen