What are the recommended first-line treatments for managing osteoarthritis in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Offer individualized management plans based on severity, affected joints, physical function, and comorbidities .

Advise on self-care strategies, including weight management, appropriate footwear, and sources of information and support .

Recommend therapeutic exercise, including local muscle strengthening and general aerobic fitness, with consideration of supervised sessions , .

Advise that joint pain may increase initially when starting therapeutic exercise, but regular exercise will be beneficial long-term , .

Use simple analgesia, such as over-the-counter topical NSAIDs like ibuprofen 5% gel applied up to three times daily for knee OA, or consider topical NSAIDs for other joints .

If topical NSAIDs are ineffective or unsuitable, consider oral NSAIDs, using the lowest effective dose for the shortest possible time, with caution regarding contraindications and risks , .

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