Osteoarthritis: new roles for drug therapy and surgery. Interview by Peter Pompei.

In patients with a confirmed diagnosis of osteoarthritis, acetaminophen is now recommended as first-line medical therapy. Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is usually discouraged, although these agents may be effective for an acute process or in patients with gout, ankylosing spondylitis, or other type of inflammatory arthritis. In patients who do not respond to or cannot tolerate acetaminophen or an NSAID, an opioid analgesic is a safe, effective alternative. In patients who continue to experience disabling pain despite lifestyle changes and drug therapy, consider an orthopedic consultation for possible surgery. Patients who are bedridden, wheelchair-bound, or have advanced cardiovascular or renal disease are poor candidates for surgery, as are those who are unable to undergo proper rehabilitation.