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

Offer a topical non-steroidal anti-inflammatory drug (NSAID) to people with knee osteoarthritis.

Consider a topical NSAID for people with osteoarthritis that affects other joints.

If topical medicines are ineffective or unsuitable, consider an oral NSAID for people with osteoarthritis, taking into account potential gastrointestinal, renal, liver, and cardiovascular toxicity, as well as individual risk factors, including age, pregnancy, current medication, and comorbidities.

Offer a gastroprotective treatment, such as a proton pump inhibitor, for people with osteoarthritis while they are taking an NSAID.

Use pharmacological treatments alongside non-pharmacological treatments and to support therapeutic exercise, at the lowest effective dose for the shortest possible time.

Do not routinely offer paracetamol or weak opioids unless they are only used infrequently for short-term pain relief and all other pharmacological treatments are contraindicated, not tolerated, or ineffective.

Explain to people with osteoarthritis that there is no strong evidence of benefit for paracetamol.

Do not offer glucosamine or strong opioids to manage osteoarthritis.

If the person asks about glucosamine or strong opioids, explain that there is no strong evidence of benefit for glucosamine and that the risks of strong opioids outweigh the benefits.

Consider intra-articular corticosteroid injections when other pharmacological treatments are ineffective or unsuitable, or to support therapeutic exercise, noting they only provide short-term relief (2 to 10 weeks).

Follow-up should include reviewing the need for ongoing treatment and considering patient-initiated follow-up for most people with osteoarthritis.

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