American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended first-line therapy for knee and hip osteoarthritis in patients without contraindications?

1. Topical analgesics

2. Oral NSAIDs

3. Corticosteroid injections

4. Physical therapy

The correct answer is: Oral NSAIDs

The recommended first-line therapy for knee and hip osteoarthritis in patients without contraindications is oral NSAIDs (non-steroidal anti-inflammatory drugs). This choice is supported by a wealth of guidelines and clinical evidence that emphasize the analgesic and anti-inflammatory properties of NSAIDs, which effectively reduce pain and improve function in patients with osteoarthritis. Oral NSAIDs are particularly beneficial for their systemic effects, which can address widespread symptoms of osteoarthritis. They are effective in managing pain, which is a primary concern for patients with this degenerative joint disease. Additionally, the risk of gastrointestinal side effects, although present, can often be managed with the use of gastroprotective agents. The accessibility and well-established use of oral NSAIDs in clinical practice also contribute to their position as a first-line treatment option. While other options like topical analgesics, corticosteroid injections, and physical therapy may have their roles in managing osteoarthritis, they are often considered adjunctive treatments or alternatives for specific patients. Topical analgesics may be more suitable for localized joint pain and may provide less systemic side effects, but they tend to yield less overall efficacy compared to oral NSAIDs. Corticosteroid injections can provide temporary relief but are not intended for long-term management due to potential