RECOMMENDATIONS from NICE CG059 Osteoarthritis

If a person with osteoarthritis needs to take low dose aspirin, healthcare professionals should

consider other analgesics before substituting or adding an NSAID or COX-2 inhibitor (with a

PPI) if pain relief is ineffective or insufficient.

All oral NSAIDs/COX-2 inhibitors have analgesic effects of a similar magnitude but vary in

their potential GI, liver and cardio-renal toxicity and therefore when choosing the agent and

dose, healthcare professionals should take into account individual patient risk factors,

including age. When prescribing these drugs, consideration should be given to appropriate

assessment and/or ongoing monitoring of these risk factors.

When offering treatment with an oral NSAID/COX-2 inhibitor, the first choice should be

either a standard NSAID or a COX-2 inhibitor (other than etoricoxib 60 mg). In either case,

these should be coprescribed with a proton pump inhibitor (PPI), choosing the one with the

lowest acquisition cost.

Oral NSAIDs/COX-2 inhibitors should be used at the lowest effective dose for the shortest

possible period of time.

Where paracetamol or topical NSAIDs provide insufficient pain relief for people with

osteoarthritis, then the addition of an oral NSAID/COX-2 inhibitor to paracetamol should be

considered.