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Pregnancy:
n acetaminophen (650–1000 mg PO QID)
n prednisone (1 mg/kg PO QD)
n intra-articular corticosteroid injection (if infection is ruled out) is performed
at the Massachusetts General Hospital for pregnant patients with
inflammatory arthritis
Pediatric: NSAID (e.g. liquid naproxen 10 mg/kg PO BID)
Special cases:
n previous colchicine efficacy and tolerance: colchicine 0.6 mg PO q1 h until
pain relief or GI side effects (maximum 10 doses/day)
n if NSAIDs and corticosteroids are ineffective or contraindicated: colchicine
(for gout) or corticotropin (40–80 units IM q8–12 h for two or three
doses)
n significant renal disease and gout or pseudogout: corticotropin (two or three
doses of 40–80 units IM, administered 8–12 h apart)
n infectious arthritis ruled out with certainty: intra-articular injection of
corticosteroid (e.g. methylprednisolone 10–40 mg depending on joint
size)
OSTEOARTHRITIS
First line: NSAID (e.g. diclofenac 25–50 mg PO TID)
Reasonable:
n acetaminophen (for mild pain), 650–1000 mg PO QID
n short-course COX-2 selective NSAID therapy (e.g. celecoxib 200 mg PO
BID), if favorable GI/cardiovascular risk profile
Pregnancy:
n acetaminophen (650–1000 mg PO QID)
n prednisone (1 mg/kg PO QD)
Arthritis 103
n intra-articular corticosteroid injection (if infection is ruled out) is performed
at the Massachusetts General Hospital for pregnant patients