title: Safely Managing Acute Osteoarthritis in the Emergency Department: An Evidence-Based Review.
abstract: BACKGROUND
  Joint pain caused by acute osteoarthritis (OA) is a common finding in the emergency department. Patients with OA often have debilitating pain that limits their function and ability to complete their activities of daily living. In addition, OA has been associated with a high percentage of arthritis-related hospital admissions and an increased risk of all-cause mortality. Safely managing OA symptoms in these patients can present many challenges to the emergency provider.
  
  
  OBJECTIVE
  We review the risks and benefits of available treatment options for acute OA-related pain in the emergency department. In addition, evidence-based recommendations will be made for safely managing pain and disability associated with OA in patients with comorbidities, including cardiovascular disease, renal insufficiency, and risk factors for gastrointestinal bleeding.
  
  
  CONCLUSIONS
  Commonly used treatments for OA include acetaminophen, oral nonsteroidal anti-inflammatory drugs, and opioids, each with varying degrees of efficacy and risk depending on the patient's underlying comorbidities. Effective alternative therapies, such as topical preparations, intra-articular corticosteroid injections, bracing, and rehabilitation are likely underused in this setting.
  
  
  CONCLUSIONS
  Emergency providers should be aware of the risks and benefits of all treatment options available for acute OA pain, including oral medications, topical preparations, corticosteroid injections, bracing, and physical therapy.
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Young
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Bothwell
authors.affiliation: Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Walsh
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D000279:Administration, Cutaneous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001915:Braces; D017679:Cryotherapy; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D006801:Humans; D007270:Injections, Intra-Articular; D059352:Musculoskeletal Pain / Q000188:drug therapy* / Q000209:etiology; D010003:Osteoarthritis / Q000150:complications / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen
keywords: arthralgia; arthritis; nonsteroidal anti-inflammatory agents; osteoarthritis