American Board of Internal Medicine (ABIM) Certification Practice Exam

According to the American College of Rheumatology, which treatment is preferred for patients aged 75 years or older with osteoarthritis?

1. Oral NSAIDs

2. Topical NSAIDs

3. Intra-articular glucocorticoids

4. Acetaminophen

The correct answer is: Topical NSAIDs

In the context of managing osteoarthritis in patients aged 75 years or older, the recommendation for topical NSAIDs as the preferred treatment aligns with current best practices that emphasize safety and efficacy in this age group. Topical NSAIDs provide localized pain relief while minimizing systemic exposure, thereby reducing the risk of adverse effects, particularly gastrointestinal and renal complications that are more prevalent in older adults who may have comorbidities or polypharmacy. Topical agents also circumvent the common side effects associated with oral NSAIDs, such as gastrointestinal bleeding and cardiovascular risks, which are significant concerns in elderly populations. This makes topical NSAIDs a safer alternative for managing pain in osteoarthritis, allowing older patients to maintain mobility and quality of life with a lower risk profile. While acetaminophen is often recommended as a first-line treatment due to its general safety profile, it may not be sufficiently effective for all patients with osteoarthritis pain, especially in those with more significant discomfort. Intra-articular glucocorticoids can be useful for localized symptoms but are not suitable as a first-line treatment for chronic pain management due to potential joint deterioration with repeated use. Thus, the preference for topical NSAIDs reflects a careful consideration of balancing benefits with potential risks, making it the optimal choice