According to the American College of Rheumatology, which medication is first-line for OA pain after nonpharmacologic interventions have failed?

• A. Metaxalone
• B. Acetaminophen
• C. Ibuprofen
• D. Tramadol

Answer: (C)

The main idea is that once nonpharmacologic approaches don’t provide enough relief, the preferred first-line pharmacologic treatment for osteoarthritis pain is an NSAID. Ibuprofen is a typical oral NSAID and is favored because it more effectively reduces both pain and inflammation in OA compared with acetaminophen, often improving function as well. Acetaminophen has a more modest effect in OA and doesn’t address inflammation, so it’s not the preferred first option when NSAIDs are suitable. Muscle relaxants like metaxalone don’t target OA pathology and aren’t used as first-line therapy. Tramadol carries risks of dizziness, nausea, and dependence, so it’s generally reserved for cases where NSAIDs can’t be used or where pain remains uncontrolled after NSAIDs. In short, ibuprofen fits the role of the best initial pharmacologic choice after nonpharmacologic methods fail, used at the lowest effective dose for the shortest duration while weighing GI, renal, and cardiovascular risks.