# Osteoarthritis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 - paracetamol (oral) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) · Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) · Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK482326; PMID: 29493951. · Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) - Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Paracetamol — 500 mg — oral.solid - Celecoxib — 200 mg — oral.solid - Naproxen — 500 mg — oral.solid - Duloxetine — 60 mg — oral.solid ## Complete treatment card ```text OSTEOARTHRITIS Sources: MSF Essential Drugs 2024 - paracetamol (oral) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) · Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) · Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK482326; PMID: 29493951. · Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Joint pain, stiffness, and restricted movement form the classic triad [joint pain · reduced range of movement] - Muscle weakness and poor balance can also occur [muscle weakness · unsteadiness] - Pain tracks with activity and eases with rest early on, becoming more constant and disabling as disease advances - Patients say the joint feels like it is giving way or buckling, reflecting muscle weakness underneath [joint instability · muscle weakness] - Morning stiffness lasting under 30 minutes supports the diagnosis [joint stiffness] SIGNS - what you find (4) - Bony enlargement, crepitus, and non-inflammatory joint effusions with limited range of motion are typical exam findings [crepitus · reduced range of movement] - Tenderness along the joint line and pain with passive movement are common - Bony swellings at the finger's end joints and middle joints, plus thumb-base squaring, mark hand involvement - It typically involves the finger end and middle joints, thumb base, hips, knees, big toe joint, and lower spine, and can affect one or many joints TESTS (5) - It can be diagnosed clinically when pain worsens with activity, the patient is over 45, morning stiffness is under 30 minutes, and there is bony enlargement with restricted movement - Routine blood markers such as CBC, ESR, rheumatoid factor and ANA are usually normal and are mainly ordered to exclude inflammatory arthritis - Synovial fluid, if sampled, shows a white cell count under 2000/microL with mostly mononuclear cells, a non-inflammatory pattern - X-rays can show marginal bone spurs, joint space narrowing, subchondral thickening and cysts, though findings do not track disease severity and may be absent early on - MRI can pick up osteoarthritis earlier than plain x-rays but is not part of the routine work- up IF NOT THIS - what else fits (5) - Rheumatoid arthritis is on the differential and should be distinguished from osteoarthritis - Psoriatic arthritis is on the differential for joint pain - Crystalline arthritis, such as gout or pseudogout, is on the differential - Hemochromatosis is on the differential, since it can cause joint disease - Avascular necrosis of the bone is on the differential Source StatPearls "Osteoarthritis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Non-NSAID option when NSAIDs are unsafe or have not helped MAIN TREATMENT - choose one 1. IBUPROFEN [1st line] Adult 400-600 mg TID with food (max 2400 mg/day) - short-term Peds Not indicated for pediatric osteoarthritis Source Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) Why NSAID that reduces joint pain and inflammation through COX inhibition; a first-line pharmacologic option for osteoarthritis pain. Caution Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus). Co-prescribe a proton pump inhibitor (PPI) for all patients taking oral NSAIDs for osteoarthritis. Use lowest effective dose for shortest duration to minimize cardiovascular and gastrointestinal risks. Contraindicated in severe heart failure, active peptic ulcer disease, and severe renal impairment. Take with or after food. The SmPC's usual range is 1200-1800 mg daily; 2400 mg is its ceiling for severe or acute disease only, not a routine target. It also warns that high-dose ibuprofen, specifically 2400 mg/day, carries a small increased risk of myocardial infarction and stroke - which matters in osteoarthritis, where the drug is taken for years rather than days. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. PARACETAMOL [2nd line] Adult 500-1000 mg QID as needed (max 4000 mg/day) - as-needed Peds Not indicated for pediatric osteoarthritis Source MSF Essential Drugs 2024 - paracetamol (oral) Why NICE NG226 (2022) 1.4.5 advises against ROUTINE paracetamol for osteoarthritis unless it is used only infrequently for short-term relief and all other pharmacological treatments are contraindicated, not tolerated or ineffective, noting there is no strong evidence of benefit; retained as 2nd-line simple analgesic in Egyptian primary care for that narrower, non-routine use. Caution Do not exceed 4 g/day from all sources to avoid hepatotoxicity. Reduce max daily dose (2-3 g) in severe liver disease. Paracetamol has minimal anti-inflammatory effect and is for mild-moderate pain. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 3. CELECOXIB [2nd line] Adult 100-200 mg once daily or 100 mg BID - short-term Peds Not indicated for pediatric osteoarthritis Source Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) Why Selective COX-2 inhibitor providing analgesic and anti-inflammatory effect similar to non-selective NSAIDs but with a lower gastrointestinal ulcer risk, chosen as the alternative when GI risk is the limiting factor; still carries its own cardiovascular risk as noted in the cautions. Caution Contraindicated in sulfonamide allergy and active peptic ulcer. There is an increased risk of cardiovascular thrombotic events (MI, stroke). Use lowest effective dose for shortest duration possible. Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus). Egypt RHEUMAMAX 200MG 20 CAPS. HI-PHARM 52.00 EGP (2.60/unit) CELOXIB 200MG 10 CAPS. SEDICO 28.80 EGP (2.88/unit) ARYTHREX 200MG 20 CAPS. AMOUN 94.00 EGP (4.70/unit) CELECOX 200MG 10 CAPS. MEMPHIS 49.00 EGP (4.90/unit) CELEBORG 200 MG 20 CAPS. BORG 99.00 EGP (4.95/unit) EUROCOX 200MG 10 TAB. EUROPEAN EGYP... 67.00 EGP (6.70/unit) CELEBREX 200MG 10 CAPS. PFIZER > VIAT... 132.00 EGP (13.20/unit) CELEBREX 200MG 15 CAPS. PFIZER > VIAT... 198.00 EGP (13.20/unit) 4. NAPROXEN [2nd line] Adult 500 mg BID with food - short-term Peds Specialist use only for pediatric arthritis Choice Alternatives. NICE NG226 advises against paracetamol for osteoarthritis, which leaves the two NSAIDs; naproxen costs 4-11 EGP against celecoxib's 29-198. Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why Naproxen is an NSAID that inhibits cyclooxygenase to reduce the pain and inflammation of osteoarthritis; among NSAIDs it carries a comparatively favorable cardiovascular risk profile, one reason to favor it here, though the GI risk that all NSAIDs share still needs a co-prescribed PPI. Caution Take with food or milk to minimize GI irritation. Favorable CV risk profile vs other NSAIDs, but GI risk remains high. Co-prescribe PPI for gastroprotection. Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus). Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) NON-NSAID OPTION WHEN NSAIDS ARE UNSAFE OR HAVE NOT HELPED 5. DULOXETINE [3rd line] Adult 60 mg once a day, started at 30 mg once a day for one week to let the patient settle on it Peds Not for children - safety and effectiveness in children have not been established, and osteoarthritis is an adult disease. Source Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031) - verbatim: "Chronic Musculoskeletal Pain - The recommended dose for Duloxetine Delayed-release Capsules is 60 mg once daily. Dosing may be started at 30 mg for one week, to allow patients to adjust to the medication before increasing to 60 mg once daily." Why Every other option listed is paracetamol or an NSAID, so the patient with peptic ulcer, renal impairment, heart failure or anticoagulation has nothing left. Duloxetine acts centrally rather than on the joint and is the option the article names for that gap. Caution Do not give with a monoamine oxidase inhibitor, within 14 days of stopping one, or alongside linezolid, and do not use it in uncontrolled narrow-angle glaucoma. Avoid it in anyone with chronic liver disease or substantial alcohol use - fatal hepatic failure has been reported; stop the drug if jaundice appears. Warn about the first weeks: watch for worsening mood or suicidal thinking, particularly in younger adults, and review early. Review the pain benefit before continuing it long- term. It raises blood pressure and can cause nausea, dry mouth and drowsiness; taper it when stopping, because abrupt withdrawal causes dizziness and paraesthesiae. Egypt DULOPRESSIVE 60 MG 30 CAPS. GLOBAL NAPI P... 174.00 EGP (5.80/unit) DEPRETREVE 60MG 20 CAPS. INTERNATIONAL... 148.00 EGP (7.40/unit) DULOXEPRIN 60 MG 28 CAPS. FUTURE PHARMA... 214.00 EGP (7.64/unit) CYMBATEX 60 MG 30 CAPS. EVA PHARMA 295.50 EGP (9.85/unit) DUCANDES 60 MG 28 CAPSULES MASH PREMIERE... 280.00 EGP (10.00/unit) CYMBALTA 60 MG 28 CAPS. ELI LILLY 544.00 EGP (19.43/unit) DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS. ZETA PHARMA 231.00 EGP WADILOXTIN 60 MG 28 DEL. REL. CAPS. WADI ELNEEL BENTA 280.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)