American Board of Internal Medicine (ABIM) Certification Practice Exam

What medication should be initiated in patients with osteoarthritis if first-line therapy with acetaminophen does not provide adequate relief?

1. Aspirin

2. Opioids

3. An NSAID

4. Corticosteroids

The correct answer is: An NSAID

In the management of osteoarthritis, if acetaminophen does not provide sufficient pain relief, the next step typically involves initiating a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are specifically effective in treating osteoarthritis-related pain and inflammation due to their ability to inhibit cyclooxygenase (COX) enzymes, which play a crucial role in the inflammatory process. Their usage aligns with clinical guidelines, as they have a well-established efficacy profile for osteoarthritis pain management. Options like opioids can also be used in cases of inadequate relief, but they come with a higher risk of side effects and dependency, making them less favorable as a first choice when NSAIDs are available and effective. Corticosteroids may be considered for severe inflammation or acute exacerbations but are not typically first-line treatments for chronic pain management associated with osteoarthritis. Thus, initiating an NSAID after acetaminophen provides insufficient relief is supported by the clinical evidence and guidelines focusing on optimizing patient management while minimizing risks associated with more potent medications.