How do you approach prescribing analgesics for osteoarthritis related pain in patients with comorbidities, particularly given new evidence that even acetaminophen is associated with increased risk of GI complications (bleeding, peptic ulcer disease), heart failure and CKD?

Acetaminophen is still preferred, but at 3,000 mg or less per day. The next consideration is a COX-2 specific inhibitor, such as celebrex. Narcotics and steroids play no role in management of osteoarthritis.

This is such an important question given the prevalence of painful osteoarthritis (knees and other joints, including erosive/inflammatory OA in the hands) in elderly patients who often have concurrent gastrointestinal, cardiac and renal disease.

The recently published retrospective study from the Un...