Which is the first-line drug used to treat osteoarthritis-related pain?

• A. Paracetamol
• B. Naproxen
• C. Celecoxib
• D. Rofecoxib

Answer: (A)

Paracetamol is used first because it provides reliable pain relief with a much safer overall profile than NSAIDs for many patients with osteoarthritis. It reduces pain mainly through central mechanisms, and it has minimal effects on the gastrointestinal tract, kidneys, or cardiovascular system. This makes it a good starting option, especially for older adults or those with risk factors for NSAID-related complications.

Dosing is important: adults can usually take up to about 3–4 grams per day, but it must be lowered in liver impairment or with chronic alcohol use to avoid hepatotoxicity. If paracetamol doesn’t control symptoms, NSAIDs like naproxen or a COX-2 inhibitor can be added or swapped in, though they carry higher risks of GI ulcers, kidney injury, and cardiovascular events. One NSAID, rofecoxib, was withdrawn from use due to cardiovascular safety concerns, so it’s not a default choice. For localized pain, topical NSAIDs can provide relief with fewer systemic risks. Non-drug therapies and exercise also play important roles alongside medication.