American Board of Internal Medicine (ABIM) Certification Practice Exam

What is recommended for treatment in patients who have not responded to previous osteoarthritis therapies, including NSAIDs?

1. Physical therapy

2. Duloxetine

3. Intra-articular glucocorticoids

4. Oral opioids

The correct answer is: Intra-articular glucocorticoids

Intra-articular glucocorticoids are often recommended for patients with osteoarthritis who have not responded adequately to previous therapies, including nonsteroidal anti-inflammatory drugs (NSAIDs). These corticosteroids are injected directly into the affected joint, allowing for localized anti-inflammatory effects, which can provide significant pain relief and improve joint functionality. This approach is particularly beneficial in cases where systemic treatments have not offered sufficient relief and can be used for various joints affected by osteoarthritis. The targeted delivery minimizes systemic side effects while maximizing therapeutic effects on the inflamed joint. Other treatments, such as physical therapy and duloxetine, may have their place in the broader management of osteoarthritis, especially in regard to enhancing function and managing chronic pain; however, they are generally considered adjuncts rather than primary options after the failure of initial therapies. Oral opioids are typically reserved for more severe, unmanageable pain due to their potential for addiction and various side effects. Therefore, intra-articular glucocorticoids stand out as a more immediate and effective intervention for patients who have not found relief through other means.