What are the management options for osteoarthritis (degenerative joint disease) in a 77-year-old male?

From the Guidelines

Management of osteoarthritis in a 77-year-old man should prioritize non-pharmacological interventions, including physical therapy, weight management, and use of assistive devices, as recommended by the most recent guidelines 1.

Key Recommendations

• The approach should start with an individualized, multicomponent management plan that includes core non-pharmacological approaches, such as exercise programs tailored to the patient's physical function and preferences 1.
• Education on self-management strategies, including information on maintaining a healthy weight, should be provided and reinforced at subsequent clinical encounters 1.
• Exercise programs should be offered, including strength, aerobic, flexibility, or neuromotor exercises, with the mode of delivery selected based on local availability and patient preferences 1.
• For pain management, acetaminophen can be considered at 650-1000 mg three to four times daily, not exceeding 3000 mg/day in elderly patients, with careful monitoring for side effects 1.
• Topical NSAIDs, such as diclofenac gel 1% applied to the affected joint four times daily, can offer localized pain relief with minimal systemic absorption for patients with insufficient relief from acetaminophen 1.
• Oral NSAIDs may be used cautiously at the lowest effective dose for the shortest duration possible, with careful monitoring for gastrointestinal, renal, and cardiovascular side effects, particularly in elderly patients 1.
• Intra-articular corticosteroid injections can provide temporary relief for flare-ups, limited to 3-4 injections per year, and joint replacement surgery should be considered if conservative measures fail and pain significantly impacts quality of life 1.

Considerations

• The management plan should be based on shared decision-making, considering the needs, preferences, and capabilities of the individual patient 1.
• Assistive devices, such as walking aids and appropriate footwear, should be considered to reduce pain and increase participation 1.
• Elements of behavior change techniques can be employed when lifestyle modifications are needed, such as physical activity and weight loss 1.
• The patient's overall health, including potential comorbidities and medication interactions, should be considered when selecting management options 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 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 Geriatric Patients The hepatic and renal tolerability of long-term naproxen administration was studied in two double-blind clinical trials involving 586 patients. Of the patients studied, 98 patients were age 65 and older and 10 of the 98 patients were age 75 and older.

Management of osteoarthritis in a 77-year-old man may include the use of naproxen, as it has been shown to reduce joint pain and improve mobility in patients with osteoarthritis.

• The therapeutic effects of naproxen in osteoarthritis include reduction in joint pain, increase in range of motion, and improvement in daily activities.
• Geriatric patients, including those over 75 years old, have been studied in clinical trials, and naproxen has been found to be tolerable in this population. 2

From the Research

Management of Osteoarthritis in a 77-Year-Old Man

Non-Pharmacological Interventions

• Education, advice, or information about the etiology, progression, prognosis, and treatment options of OA are recommended as an ongoing and integral part of care 3
• Weight loss (if overweight) is an important core treatment in knee and hip OA 3
• Exercise is a key core treatment in knee, hip, and hand OA and should be considered regardless of age, structural disease severity, functional status, pain levels, or the presence of comorbidities 3
• Walking aids/devices are recommended for both hip and knee OA, while orthoses are recommended for patients with carpometacarpal (CMC) joint OA 3

Pharmacological Interventions

• Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line therapy for OA, but selection is challenged by patient age, comorbidities, and polypharmacy, and by the drug's benefit/risk balance 4
• Acetaminophen is recommended as a first-line treatment for mild-to-moderate pain associated with OA 5, 6
• Intra-articular corticosteroids are generally recommended for OA management and have relatively minor adverse effects 5, 7
• Oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function, but are associated with increased risks in patients with certain comorbidities 7

Treatment Considerations

• Patient-specific parameters and comorbid conditions must be considered when evaluating treatment options for older adults 6
• The individual baseline risk and the drug's safety profile are major determinants of cardiovascular, gastrointestinal, and renal risk, and possible drug-drug interactions should be considered 4
• Periodical re-evaluation of treatment response and adherence, using scales to assess pain and function, is recommended 4