Q.1
“Current guidelines recommend regular paracetamol to manage pain in patients with osteoarthritis” *

The correct answer is False. Guidelines no longer recommend regular paracetamol because of its minimal effect on pain and increasing evidence of gastrointestinal, cardiovascular and renal adverse reactions, along with increased mortality risk[13].

Q.2
Marie is prescribed naproxen, an oral non-selective non-steroidal anti-inflammatory drug (nsNSAID). How does the safety and efficacy of topical NSAIDs compare to that of oral NSAIDs? *

The correct answer is topical NSAIDs have similar efficacy to oral NSAIDs in reducing pain, with reduced risk of systemic adverse events. Topical NSAIDs are preferred to oral NSAIDs for knee and hand OA[2,3].

Q.3
Marie continues to be treated with NSAIDs with a PPI but takes tramadol intermittently for breakthrough pain. How does the level of pain relief offered by NSAIDs compare to that offered by opioids in OA? *

The correct answer is similar. Two meta-analyses have shown similar pain relief to oral NSAIDs in OA[17,18]. Given the risk of chemical dependence, opioids are either strongly recommended against for all OA phenotypes (OARSI)[1] or weakly recommended as a last resort or when joint replacement is contraindicated (ESCEO)[2].

Q.4
As Marie’s symptoms worsened, she elected to receive intra-articular glucocorticoid injections. Which of the following is not a potential advantage of intra-articular glucocorticoid injections? *

The correct answer is long-term benefits. Short-term treatment with intra-articular corticosteroids is recommended since meta-analyses have shown less evidence of long-term benefits (post-4 weeks after injection)[12].

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