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?

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...

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.

I do have a sneaking suspicion that patients who don’t have their pain adequately controlled by physician prescriptions and believe that they need to take pharmacological treatments for relief will try to get that relief elsewhere. What do people think about this? How do we take this into account?

The issue with acetamenophen may actually be excessive ingestion. Rather than concentrate on pharmacologics, my recommendation is joint protection - occupational therapy assessment and ADL accommodations with assistive devices.