Management of osteoarthritis in older people

Osteoarthritis is a common cause of disability in the elderly. Management involves pharmacological and non-pharmacological therapies, often in combination. Paracetamol is regarded as the drug of first choice in the management of pain, however anti-inflammatory drugs or other analgesics should be considered if regular paracetamol fails. If conventional non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 specific inhibitors are prescribed, attention should be paid to gastrointestinal, hepatic, cardiac and renal risk factors. Recent research indicates that some complementary and alternative medicines (e.g. glucosamine) are effective and should be considered, particularly given their low side effect profile. The evidence around surgical procedures mostly supports arthroplasty (joint replacement) for severe, refractory knee osteoarthritis; however arthroscopy has generally been found to be ineffective. Physical therapies, weight loss and joint protection also have a place in management and given that osteoarthritis contributes to psychological morbidity, supportive programs such as the Arthritis Self-Management Course should also be routinely recommended.