Weight-bearing joints worse with use; Heberden/Bouchard nodes
Treat: Weight loss + exercise → topical NSAID (knee/hand) first-line → oral NSAID shortest course with PPI → intra-articular steroid → joint replacement; paracetamol NOT routine (NICE NG226 2022)
Order set
- Clinical diagnosis
- X-ray if needed
- Function/weight assessment
Criteria
AdmitRarely (severe pain/function)
DischargeAnalgesia + exercise, replacement referral if severe
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Rest/night pain, systemic features (reconsider dx)
Differentials
- Inflammatory arthritis
- Gout
- Referred pain
Common mistakes
- Over-imaging
- NSAIDs without gastro/renal caution
Disposition & follow-up
Exercise, weight loss, analgesia; joint replacement if severe.
Discharge package
MedicationsTopical NSAID first-line (knee/hand); oral NSAID shortest course; do NOT offer glucosamine/chondroitin (NICE NG226)
Follow-upPhysio; joint replacement referral if severe
LifestyleWeight loss, exercise
Warning symptomsLocking, severe pain, function loss
💊 Treatment detail — doses & preparation
Paracetamolanalgesia — NOT routine in OA (NICE NG226 2022)
DoseOnly infrequent short-term use when NSAIDs/IA injections contraindicated or ineffective: 1 g QID PRN (max 4 g/day; 3 g if frail/low weight)
Preparation500 mg tablets
MonitorTotal daily dose including combination products
NaproxenNSAID
Dose500 mg BD with food (OA pain — shortest effective course)
Preparation250/500 mg tablets; add PPI if risk factors
MonitorRenal function, GI bleeding, BP; avoid in CKD/HF
Topical NSAID/capsaicinlocal
DoseIbuprofen gel TDS to affected joint (first-line knee/hand); capsaicin only for hand OA — NICE NG226 recommends against it for knee
PreparationRub in, wash hands
MonitorSkin irritation; first-line for knee/hand OA
📖 ACR / OARSI OsteoarthritisReviewed July 2026