From the Guidelines
For a 64-year-old male with early degenerative arthritis of the right hip causing pain while walking and in bed, I recommend a multimodal approach including medication and physical therapy. The treatment plan includes naproxen 500 mg twice daily as needed for pain relief, along with Tylenol 325 mg 1-3 tablets three times daily as needed, not exceeding 3000 mg per day, as supported by the EULAR evidence-based recommendations for the management of hip osteoarthritis 1. Physical therapy should also be initiated to improve hip mobility and strengthen supporting muscles, as recommended by the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1. Since the patient's BMI is within normal range at 24.48, maintaining his current weight is important to avoid additional stress on the affected joint, as highlighted in the 2020 US Department of Veterans Affairs/US Department of Defense clinical practice guideline: the non-surgical management of hip and knee osteoarthritis 1. This combination therapy addresses pain through anti-inflammatory medication (naproxen) and analgesics (Tylenol), while physical therapy will help preserve function and potentially slow disease progression. The patient should be advised that naproxen may cause gastrointestinal side effects and should be taken with food, and regular follow-up is recommended to assess treatment effectiveness and disease progression. Additionally, the patient may benefit from self-efficacy and self-management programs, as well as tai chi, which are strongly recommended for patients with knee and/or hip OA, as stated in the 2019 American College of Rheumatology/Arthritis Foundation guideline 1. It is also important to consider the patient's individual preferences and access to different forms of exercise, as exercise programs are more effective when supervised and combined with self-efficacy and self-management interventions or weight loss programs 1. Overall, a multimodal approach that incorporates medication, physical therapy, and lifestyle modifications can help manage the patient's symptoms and improve his quality of life.
From the FDA Drug Label
Carefully consider the potential benefits and risks of naproxen and other treatment options before deciding to use naproxen tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals A lower dose should be considered in patients with renal or hepatic impairment or in elderly patients As with other drugs used in the elderly, it is prudent to use the lowest effective dose The recommended dose is 250 mg, 375 mg, or 500 mg twice daily The morning and evening doses do not have to be equal in size and the administration of the drug more frequently than twice daily is not necessary In patients who tolerate lower doses well, the dose may be increased to naproxen 1500 mg/day for limited periods of up to 6 months when a higher level of anti-inflammatory/analgesic activity is required.
The patient is a 64-year-old male, which is considered elderly. The recommended dose for rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis is 250 mg, 375 mg, or 500 mg twice daily.
- The dose of 500 mg BID prescribed for this patient is within the recommended range.
- However, considering the patient's age, a lower dose should be considered to minimize potential risks.
- It is recommended to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals 2.
From the Research
Treatment of Osteoarthritis
- The patient's x-ray shows early degenerative arthritic changes of the right hip, and the patient reports pain when walking or in bed 3.
- The treatment plan includes naproxen 500 mg BIDPRN, Tylenol 325 mg 1-3 tabs TIDPRN not exceeding 3000 mg daily, and physical therapy (PT) 3.
Use of Naproxen
- Naproxen has been shown to reduce articular cartilage degradation in a rat model of osteoarthritis 4.
- A 2-year study comparing naproxen and acetaminophen in the treatment of osteoarthritis of the knee found that both treatments had similar efficacy, although naproxen had slightly better efficacy 5.
- Naproxen has also been shown to be effective in treating acute pain, including dysmenorrhea, headache, and dental pain 6.
Dosing of Naproxen
- A study comparing naproxen 500 mg twice daily (BID) versus naproxen 500 mg as needed (PRN) for treatment of ankle sprain found that both regimens had similar efficacy, but the PRN regimen had a better safety profile and lower total drug use 7.
- The patient's treatment plan includes naproxen 500 mg BIDPRN, which is consistent with the study findings that naproxen can be effective in reducing pain and inflammation 3, 4, 5, 6, 7.