Managing foot osteoarthritis at first line requires selecting an appropriate oral analgesic while accounting for the patient's individual tolerability and risk profile. The choice of agent — and whether additional protective measures are warranted — depends on factors assessed at the point of care.

Treatment Approach

The first-line protocol specifies an oral analgesic strategy in which agent selection is guided by gastrointestinal risk and tolerability, with defined conditions under which protective co-prescribing is indicated — the complete regimen details which agents apply and when each is appropriate.

References

Oral NSAIDs were generally recommended for all sites of OA, but strength of recommendations (conditional/weak versus strong) varied among guidelines, primarily reflecting concerns about adverse effects.
Acetaminophen is no longer considered "first-line" for OA due to its relative poor efficacy, though it is still an option for those who have contraindications or intolerances to NSAIDs.
Consider adding proton pump inhibitor or misoprostol in patients at risk for upper gastrointestinal events who require treatment with NSAIDs or COX-2 inhibitors.

DOI: 10.1016/j.rdc.2022.03.009.

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First-Line Oral Treatment for Foot Osteoarthritis

References