Treatment of Shoulder Osteoarthritis with Contraindications or Intolerances to NSAIDs
Managing shoulder osteoarthritis becomes more complex when standard oral anti-inflammatory therapy is not an option. When a patient has a contraindication or intolerance to NSAIDs, the treatment pathway requires a different approach.
Clinical Scenario
This protocol applies to patients with shoulder osteoarthritis who cannot tolerate NSAIDs or for whom NSAIDs are contraindicated. Guidelines note that acetaminophen is no longer considered a first-line option for osteoarthritis given its limited efficacy, and opioid-based strategies carry significant caveats in this context.
Treatment Approach
For this population, a locally administered intra-articular intervention targeting the shoulder joint is among the approaches that may be considered.
Full regimen details — including sequencing, selection criteria, and complete clinical guidance — are available in the structured protocol.
References
DOI: 10.1016/j.rdc.2022.03.009.
- 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.
- Opioids, including tramadol, are generally not recommended, though guidelines did acknowledge that in some cases, such as in instances of contraindications, intolerance to, or inadequate response to NSAIDs, tramadol can be considered for pain relief in the absence of other viable options.
- IACS may be considered, whereas other intra-articular therapies were generally not recommended, or in the case of IAHA, only to be considered if other therapies have failed.