Analgesia for arthralgias, myalgias and arthritis

Arthralgias and myalgias are more common than arthritis in inflammatory connective tissue diseases, and erosive joint damage is rare.

Although paracetamol is usually less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain, its favourable safety profile in therapeutic doses justifies a trial of paracetamol first line for mild to moderate pain. For arthralgias and myalgias associated with inflammatory connective tissue disease, use:

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

OR

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

If arthralgias and myalgias are not adequately relieved by paracetamol, or for arthritis symptoms, an NSAID may be used instead of, or in combination with, paracetamol. 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 NSAID is indicated for symptoms of arthritis, 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 conditions in adults for more information).