What is the second-line analgesic for Osteoarthritis after topical NSAIDs?

• A. NSAIDs (nonselective)
• B. Opioids
• C. Corticosteroids
• D. Acetaminophen (Tylenol)

Answer: (D)

In managing osteoarthritis pain, safety and tolerability guide stepwise therapy after topical NSAIDs. Acetaminophen provides reliable analgesia with a favorable safety profile compared with systemic NSAIDs and opioids. It works centrally to reduce pain and has little to no anti-inflammatory action, which makes it a sensible choice when inflammation is not the dominant issue or when patients are at risk from NSAID-related GI, renal, or cardiovascular problems. It’s commonly well tolerated for long-term use, and it avoids many drug interactions and gastric risks associated with NSAIDs. The main caution is liver safety, so daily dosing is limited (typically up to 3 grams for adults, with lower limits in liver disease or with heavy alcohol use). In contrast, oral NSAIDs carry higher GI/CV/renal risks, opioids bring potential dependence and other adverse effects, and corticosteroids are more appropriate for episodic flares rather than ongoing analgesia.