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Traditional NSAIDs and some selective cyclooxygenase (COX)-2 inhibitors used to treat patients with osteoarthritis (OA) have adverse effects. However, traditional NSAIDs remain first-line therapy for some patients. The toxicities (eg, renal and GI effects) mostly are the result of COX inhibition. Earlier, it was suggested that the ideal NSAID would inhibit COX-2 while sparing COX-1. The mechanisms for increased COX-2 cardiovascular toxicity remain less than fully understood. The recent accumulation of knowledge about NSAIDs probably will yield valuable insights in the next few years. Several conservative strategies may help primary care physicians use these agents effectively and safely. OA therapies under investigation (eg, inhibition of prostaglandin E syntheses and disease-modifying osteoarthritis drugs) may render NSAIDs and COX-2 inhibitors obsolete. [ABSTRACT FROM AUTHOR]

NSAIDs have been a mainstay of treatment for patients with osteoarthritis (OA), but toxicity may be a problem and cyclooxygenase-2 inhibitors may increase cardiovascular risk. Current OA treatments combine several approaches to alleviate symptoms. Patient education and physical and occupational therapy are valuable components. Support appliances help stabilize joints and improve function. Weight loss is recommended in patients who have a high body mass index. Studies of complementary and alternative medicine therapies are inconclusive. Surgery may be indicated. Acetaminophen is considered first-line pharmacologic therapy for mild to moderate OA. Opioid analgesics are useful in patients with moderate to moderately severe pain. Intra-articular corticosteroids can relieve pain and reduce effusions. Topical NSAIDs and capsaicin may reduce OA-related pain. [ABSTRACT FROM AUTHOR]