Treatment of Shoulder Osteoarthritis When There Are No Contraindications or Intolerances to NSAIDs
When a patient with shoulder osteoarthritis has no contraindications or intolerances to NSAIDs, a structured first-line approach is indicated. Both pharmacologic and non-pharmacologic interventions play a role in this setting.
Clinical Scenario
This protocol applies to patients with shoulder osteoarthritis who have no contraindications or intolerances to non-steroidal anti-inflammatory drugs (NSAIDs), making a broader range of first-line treatment options available. Oral and topical NSAID formulations are the pharmacologic agents most recommended for osteoarthritis, though appropriateness depends on individual patient factors.
Treatment Approach (Partial Overview)
First-line management combines education and self-management programs with regular low-impact aerobic exercise. For eligible patients, oral or topical NSAIDs may be considered as part of the pharmacologic component — with additional measures for those at risk for certain gastrointestinal events.
The complete regimen, sequencing, and specific recommendations are available in the full structured protocol.
References
DOI: 10.1016/j.rdc.2022.03.009.
- Education and self-management constitute a key component of OA management.
- Referral to self-management programs should be provided, and patients should receive education on OA, management approaches, joint protection strategies, and exercise.
- Patients with OA should be advised to engage in regular low impact aerobic exercise (land or aquatic-based) and to lose weight if overweight.
- Oral and topical NSAIDs are the pharmacologic agents most recommended for OA, though oral formulations should be avoided in those with contraindications and intolerances, and topical formulations are not appropriate for a deep joint such as the hip.
- Consider adding proton pump inhibitor or misoprostol in patients at risk for upper gastrointestinal events who require treatment with NSAIDs or COX-2 inhibitors.
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