Initial symptomatic treatment for inflammatory monoarthritis in adults

Symptomatic treatment with analgesia should be offered to people with inflammatory monoarthritis. Treat them symptomatically while awaiting diagnostic confirmation. This may include simple analgesics and anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used because of their known efficacy in treating pain, stiffness and swelling associated with established inflammatory rheumatological disease.

All of the NSAIDs listed below are equally effective, and drug choice should be based on patient factors (eg comorbidities)–see Choosing an NSAID for advice on drug choice. If an oral NSAID is indicated for mild to moderate inflammatory monoarticular joint pain, use:

1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib

OR

1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib

OR

1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen

OR

1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin

OR

1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen

OR

1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam

OR

1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen

OR

1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen

OR

1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam

OR

2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac

The potential benefits of an NSAID should be weighed against its potential harms, particularly in people at high risk of harms (see Principles of NSAID use for musculoskeletal pain for more information).

Although paracetamol is generally less effective than NSAIDs for moderate to severe pain, its favourable safety profile justifies recommending it as a first-line analgesic for mild to moderate musculoskeletal pain. Paracetamol has little, if any, anti-inflammatory effect. Paracetamol may be used in combination with an NSAID, or instead of an NSAID if an NSAID is contraindicated or not tolerated. Use:

1paracetamol immediate-release 1 g orally, 4- to 6-hourly, up to a maximum of 4 g daily paracetamol paracetamol paracetamol

OR

1paracetamol modified-release 1.33 g orally, 8-hourly. paracetamol paracetamol paracetamol