American Board of Internal Medicine (ABIM) Certification Practice Exam

Older patients with osteoarthritis requiring NSAID therapy should be considered for what to manage gastrointestinal toxicity?

1. Oral steroids

2. Topical NSAID therapy

3. Intravenous NSAIDs

4. Dietary changes

The correct answer is: Topical NSAID therapy

Managing gastrointestinal toxicity in older patients with osteoarthritis who require NSAID therapy is crucial, particularly because this population is at a higher risk for adverse gastrointestinal events, including ulcers and bleeding. Topical NSAID therapy is a viable alternative as it minimizes systemic absorption and the gastrointestinal side effects commonly associated with oral NSAIDs. Topical formulations, such as gels or creams, allow for localized treatment of pain, which can be effective for musculoskeletal conditions without exposing the entire system to the potential risks of oral NSAIDs. This targeted approach helps to alleviate pain while reducing the likelihood of gastrointestinal issues, making it a suitable choice for older patients. In contrast, other options might not adequately address the concern of gastrointestinal toxicity. Oral steroids, while they may reduce inflammation, can have their own set of side effects including increased risk of gastrointestinal bleeding, particularly when used in conjunction with NSAIDs. Intravenous NSAIDs are typically used in acute settings and do not necessarily mitigate gastrointestinal risks. Dietary changes, while beneficial for overall health, do not specifically target the management of NSAID-related gastrointestinal toxicity. Thus, using topical NSAIDs is generally the most appropriate course of action.