Paracetamol Not Recommended OA — SCE Rheumatology MCQ
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Correct answer: C — Use paracetamol only infrequently for short-term relief when all other pharmacological treatments are unsuitable or ineffective
Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E
NICE NG226 advises that paracetamol should not be offered routinely for osteoarthritis because there is no strong evidence of clinically meaningful benefit. It may nevertheless be used infrequently for short-term pain relief when all other pharmacological treatments are contraindicated, not tolerated or ineffective, making B correct. A and D incorrectly position regular paracetamol within a routine analgesic sequence; NICE instead offers a topical NSAID for knee osteoarthritis and considers an oral NSAID when topical treatment is ineffective or unsuitable, accounting for toxicity and gastroprotection. C is incorrect because weak opioids are subject to the same restrictive recommendation and routine combination therapy is not advised. E is too absolute because NICE allows the specified limited exception. Pharmacological treatment should supplement information, therapeutic exercise and weight management where appropriate.
Reference: National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226), recommendation 1.4.5, 2022. https://www.nice.org.uk/guidance/ng226/chapter/recommendations