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Osteoarthritis pain with NSAID risk — SCE Geriatric Medicine MCQ

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ModerateMusculoskeletal medicineOsteoarthritis pain with NSAID riskSCE Geriatric Medicine

An 88-year-old woman with osteoarthritis and CKD3 has worsening pain limiting mobilisation after a fall. X-rays show no fracture. She takes warfarin, ramipril and furosemide; eGFR is 42 mL/min/1.73 m² and INR is 2.6. She asks for ibuprofen because it helped previously. What is the most appropriate management?

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Correct answer: A — Use regular paracetamol, topical therapy and non-pharmacological measures, avoiding oral NSAIDs where possible

Oral NSAIDs increase renal, gastrointestinal and bleeding risk in a patient with CKD, ACE inhibitor/diuretic use and warfarin. Safer analgesic strategies should support mobilisation while minimising harm. Opioids may be needed short term in selected cases but are not the first-line chronic strategy and increase delirium/falls risk. The pearl is that analgesia in older adults should be effective enough to restore function while actively managing medicine-related harm.

Reference: NICE osteoarthritis guidance; BNF; STOPP/START v3