Chronic pain
Osteoarthritis: which options to consider after treatment failure?

Anna (55 years old)

Anna, 55 years old, runs a flower shop. Her BMI is 22 and she generally feels well. In the last few years, she has experienced some health problems, as she had a cholecystectomy with complications (5 years ago) and a deep venous thrombosis (2 years ago). She has recovered quite well from these health issues but is currently suffering from pain due to knee OA, which was diagnosed 2 years ago.

She was and is still very active, e.g. going on hiking trips during the weekends. However, management of her knee pain with paracetamol and a topical NSAID does not achieve the desired result, since walking and standing for longer periods is painful.

She comes to your clinic, and you suggest switching to an oral NSAID for 1-2 weeks.

Which of the following NSAIDs would you suggest to this patient?