Is it advisable for a 68-year-old male with hip osteoarthritis, currently taking celecoxib (celecoxib) 200mg once daily, to use diclofenac (diclofenac) 2% gel for increased hip pain?

Management of Increased Hip Osteoarthritis Pain in a Patient on Celecoxib

Diclofenac 2% gel can be recommended for this patient as it can provide pain relief without significant systemic absorption, making it a safe option to use alongside his current celecoxib therapy. 1

Rationale for Recommending Topical Diclofenac

Topical diclofenac offers several important advantages for this 68-year-old patient:

• Provides localized pain relief with minimal systemic absorption, reducing risk of additional NSAID-related adverse effects 1
• Can be safely used as adjunctive therapy with oral celecoxib, as the systemic absorption is limited 1
• Particularly appropriate for elderly patients who are at higher risk for NSAID-related complications 2
• Offers quick pain relief for breakthrough pain while maintaining the patient's current regimen 1

Treatment Algorithm for Hip Osteoarthritis Pain

1. First-line therapy: Oral NSAIDs (patient is already on celecoxib 200mg daily)
2. For breakthrough pain: Add topical NSAID (diclofenac 2% gel) before considering dose increases of oral NSAIDs 3, 1
3. If inadequate response: Consider follow-up with primary care provider for potential:
   • Intra-articular corticosteroid injection (requires ultrasound guidance for hip) 3
   • Possible adjustment of oral NSAID dosing

Safety Considerations

The addition of topical diclofenac is preferable to increasing the oral celecoxib dose because:

• The 2019 American College of Rheumatology guidelines recommend using the lowest effective dose of oral NSAIDs to minimize risks 3
• Topical NSAIDs have significantly fewer gastrointestinal adverse events compared to oral NSAIDs 1
• The patient is 68 years old, placing him at higher risk for NSAID-related complications 3
• Research shows topical diclofenac is effective and well-tolerated in elderly patients 2

Application Instructions

• Apply diclofenac 2% gel to the hip area four times daily
• Use approximately 4g per application (typically a 2-inch strip of gel)
• Rub thoroughly into the skin until completely absorbed
• Wash hands after application unless treating hands
• Monitor for local skin reactions and discontinue if severe irritation occurs 1

Follow-up Recommendations

While the patient can safely use the topical diclofenac gel, he should still follow up with his primary care provider if:

• Pain persists despite the addition of topical therapy
• He experiences any adverse effects from the combined therapy
• His functional limitations continue to interfere with daily activities

At that point, his provider may consider other interventions such as ultrasound-guided intra-articular corticosteroid injection, which is strongly recommended for hip OA by the American College of Rheumatology 3.