Medical management of osteoarthritis of the knee and hip joints

■ Osteoarthritis is a common, chronic condition which requires an individualised management plan involving multiple kinds of treatment. ■ Exercise programs and the Arthritis Self-Management Program reduce pain and disability associated with osteoarthritis. ■ Paracetamol is the most appropriate first-line analgesic. ■ Non-steroidal anti-inflammatory drugs may be used as second-line analgesia on an as-needed basis (including continuous use), but must be used with caution. Cyclo-oxygenase-2-specific inhibitors are used if there are risk factors for upper-gastrointestinal complications, but only after considering cardiovascular risk. ■ Glucosamine sulfate is a safe and effective over-the-counter treatment. ■ Intra-articular therapies are used when others have failed.