What are the management options for arthralgia (joint pain)?

From the Guidelines

Joint pain management should prioritize a combination of medication, physical therapy, and lifestyle modifications, with a focus on early referral to a rheumatologist and initiation of disease-modifying antirheumatic drugs (DMARDs) as early as possible, ideally within 3 months, as recommended by the 2016 EULAR guidelines 1. The management of joint pain involves a multifaceted approach, including:

• Medications such as NSAIDs, which should be used at the minimum effective dose for the shortest time possible, and DMARDs, with methotrexate considered the anchor drug 1
• Physical therapy, including dynamic exercises and occupational therapy, to improve joint function and reduce stiffness 1
• Lifestyle modifications, such as weight management, smoking cessation, and regular low-impact exercise, to decrease joint stress and promote healing 1
• Non-pharmacological interventions, including heat and cold therapy, and assistive devices, to provide additional relief and support 1
• Patient education and self-management strategies, to empower patients to take an active role in their care and make informed decisions about their treatment 1

Key considerations in joint pain management include:

• Early referral to a rheumatologist, ideally within 6 weeks of symptom onset, to facilitate prompt diagnosis and treatment 1
• Regular monitoring of disease activity, adverse events, and comorbidities, to guide treatment decisions and optimize outcomes 1
• A multidisciplinary approach, involving primary care physicians, rheumatologists, and other healthcare professionals, to provide comprehensive and coordinated care 1

By prioritizing a combination of medication, physical therapy, and lifestyle modifications, and emphasizing early referral and initiation of DMARDs, healthcare providers can effectively manage joint pain and improve patient outcomes, as supported by the most recent and highest quality evidence 1.

From the FDA Drug Label

Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout Improvement in patients treated for rheumatoid arthritis was demonstrated by a reduction in joint swelling, a reduction in duration of morning stiffness, a reduction in disease activity as assessed by both the investigator and patient, and by increased mobility as demonstrated by a reduction in walking time In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease In patients with ankylosingspondylitis, naproxen has been shown to decrease night pain, morning stiffness and pain at rest

Joint Pain Management: Naproxen can be used for joint pain management, as it has been shown to reduce joint pain or tenderness in patients with osteoarthritis, and decrease night pain, morning stiffness, and pain at rest in patients with ankylosing spondylitis.

• Key Benefits: reduction in joint swelling, reduction in duration of morning stiffness, reduction in disease activity, increased mobility, and improvement in capacity to perform activities of daily living. 2

From the Research

Joint Pain Management Options

• Non-pharmacological conservative treatments, such as manual therapy and exercise therapy, have been shown to be effective in improving pain, hip range of motion, and physical function in patients with mild to moderate hip osteoarthritis 3
• Pharmacological treatments, such as naproxen and ibuprofen, have been compared in various studies, with naproxen being found to be as effective as ibuprofen in treating osteoarthritis of the knee 4
• Naproxen has also been found to be effective in treating rheumatoid arthritis, with some studies suggesting it may be more effective than other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and indomethacin 5, 6, 7
• The use of naproxen suppositories in combination with oral NSAIDs has been shown to be effective and well-tolerated in the treatment of rheumatoid arthritis 7

Comparison of NSAIDs

• A study comparing the efficacy of nabumetone with that of diclofenac, naproxen, ibuprofen, and piroxicam in patients with osteoarthritis (OA) or rheumatoid arthritis (RA) found that nabumetone was as effective as the comparator NSAIDs in OA, but more effective in RA 5
• Another study comparing the analgesic efficacy and safety of nonprescription doses of naproxen sodium and ibuprofen in the treatment of osteoarthritis of the knee found that both treatments were effective, but naproxen sodium provided more effective pain relief for most variables 4

Treatment Considerations

• The choice of treatment for joint pain management should be based on individual patient needs and medical history, with consideration given to the potential benefits and risks of each treatment option
• Non-pharmacological conservative treatments may be a useful adjunct to pharmacological treatments, and may help to improve physical function and reduce pain in patients with osteoarthritis 3