What is the first-line treatment for Osteoarthritis?

• A. Topical NSAIDs (e.g., diclofenac)
• B. Systemic corticosteroids
• C. Disease-modifying antirheumatic drugs
• D. Biologic agents

Answer: (A)

In osteoarthritis, the goal is to relieve pain and improve function with the least systemic risk. Topical NSAIDs deliver anti-inflammatory and analgesic effects directly to the affected joint, so you get meaningful relief where it’s needed while minimizing systemic exposure. This makes them a preferred first-line option for localized OA symptoms, such as in the knee or hand, especially in patients where oral NSAIDs carry higher GI, renal, or cardiovascular risks.

Systemic corticosteroids can help briefly in certain situations, but their long-term use carries significant side effects, so they aren’t a first-line choice for OA. Disease-modifying antirheumatic drugs and biologics target inflammatory arthritides (not OA) and aren’t appropriate as initial OA therapies.