chronic

Osteoarthritis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

MSF Essential Drugs 2024 - paracetamol (oral) · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116) · Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365) · Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK482326; PMID: 29493951. · Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031)

Verified against4 documents

MSF Essential Drugs 2024 - paracetamol (oral)
Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)
Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116)
Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

Joint pain, stiffness, and restricted movement form the classic triad [joint pain · reduced range of movement]
Muscle weakness and poor balance can also occur [muscle weakness · unsteadiness]
Pain tracks with activity and eases with rest early on, becoming more constant and disabling as disease advances
Patients say the joint feels like it is giving way or buckling, reflecting muscle weakness underneath [joint instability · muscle weakness]
Morning stiffness lasting under 30 minutes supports the diagnosis [joint stiffness]

Signs — what you find (4)

Bony enlargement, crepitus, and non-inflammatory joint effusions with limited range of motion are typical exam findings [crepitus · reduced range of movement]
Tenderness along the joint line and pain with passive movement are common
Bony swellings at the finger's end joints and middle joints, plus thumb-base squaring, mark hand involvement
It typically involves the finger end and middle joints, thumb base, hips, knees, big toe joint, and lower spine, and can affect one or many joints

Tests (5)

It can be diagnosed clinically when pain worsens with activity, the patient is over 45, morning stiffness is under 30 minutes, and there is bony enlargement with restricted movement
Routine blood markers such as CBC, ESR, rheumatoid factor and ANA are usually normal and are mainly ordered to exclude inflammatory arthritis
Synovial fluid, if sampled, shows a white cell count under 2000/microL with mostly mononuclear cells, a non-inflammatory pattern
X-rays can show marginal bone spurs, joint space narrowing, subchondral thickening and cysts, though findings do not track disease severity and may be absent early on
MRI can pick up osteoarthritis earlier than plain x-rays but is not part of the routine work-up

If not this — what else fits (5)

Rheumatoid arthritis is on the differential and should be distinguished from osteoarthritis
Psoriatic arthritis is on the differential for joint pain
Crystalline arthritis, such as gout or pseudogout, is on the differential
Hemochromatosis is on the differential, since it can cause joint disease
Avascular necrosis of the bone is on the differential

SourceStatPearls "Osteoarthritis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Non-NSAID option when NSAIDs are unsafe or have not helped

MAIN TREATMENT - choose one

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400-600 mg TID with food (max 2400 mg/day) - short-term

Paediatric dose

Not indicated for pediatric osteoarthritis

Dose source

Ibuprofen 600 mg film-coated tablets SmPC section 4.2 (eMC product 14365)

Why

NSAID that reduces joint pain and inflammation through COX inhibition; a first-line pharmacologic option for osteoarthritis pain.

Cautions

Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).
Co-prescribe a proton pump inhibitor (PPI) for all patients taking oral NSAIDs for osteoarthritis.
Use lowest effective dose for shortest duration to minimize cardiovascular and gastrointestinal risks.
Contraindicated in severe heart failure, active peptic ulcer disease, and severe renal impairment.
Take with or after food.
The SmPC's usual range is 1200-1800 mg daily; 2400 mg is its ceiling for severe or acute disease only, not a routine target. It also warns that high-dose ibuprofen, specifically 2400 mg/day, carries a small increased risk of myocardial infarction and stroke - which matters in osteoarthritis, where the drug is taken for years rather than days.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

PARACETAMOL

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500-1000 mg QID as needed (max 4000 mg/day) - as-needed

Paediatric dose

Not indicated for pediatric osteoarthritis

Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

NICE NG226 (2022) 1.4.5 advises against ROUTINE paracetamol for osteoarthritis unless it is used only infrequently for short-term relief and all other pharmacological treatments are contraindicated, not tolerated or ineffective, noting there is no strong evidence of benefit; retained as 2nd-line simple analgesic in Egyptian primary care for that narrower, non-routine use.

Cautions

Do not exceed 4 g/day from all sources to avoid hepatotoxicity.
Reduce max daily dose (2-3 g) in severe liver disease.
Paracetamol has minimal anti-inflammatory effect and is for mild-moderate pain.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FEBRIMOL 500 MG 20 TAB.	PHARCO	3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.	MEMPHIS	8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.	MUP	13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.	EIPICO	24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.	UTOPIA	42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.	MISR	38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETS	JULPHAR	32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETS	AUG PHARMA	50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solid	PHARCO	4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	5.00 EGP

CELECOXIB

2nd line

Strength200 mg

Formoral.solid

Adult dose and duration

100-200 mg once daily or 100 mg BID - short-term

Paediatric dose

Not indicated for pediatric osteoarthritis

Dose source

Celecoxib 200 mg capsules, hard SmPC section 4.2 Posology and method of administration (eMC product 2116)

Why

Selective COX-2 inhibitor providing analgesic and anti-inflammatory effect similar to non-selective NSAIDs but with a lower gastrointestinal ulcer risk, chosen as the alternative when GI risk is the limiting factor; still carries its own cardiovascular risk as noted in the cautions.

Cautions

Contraindicated in sulfonamide allergy and active peptic ulcer.
There is an increased risk of cardiovascular thrombotic events (MI, stroke).
Use lowest effective dose for shortest duration possible.
Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
RHEUMAMAX 200MG 20 CAPS.	HI-PHARM	52.00 EGP (2.60/unit)
CELOXIB 200MG 10 CAPS.	SEDICO	28.80 EGP (2.88/unit)
ARYTHREX 200MG 20 CAPS.	AMOUN	94.00 EGP (4.70/unit)
CELECOX 200MG 10 CAPS.	MEMPHIS	49.00 EGP (4.90/unit)
CELEBORG 200 MG 20 CAPS.	BORG	99.00 EGP (4.95/unit)
EUROCOX 200MG 10 TAB.	EUROPEAN EGYPTIAN PHARM. IND.	67.00 EGP (6.70/unit)
CELEBREX 200MG 10 CAPS.	PFIZER > VIATRIS EGYPT	132.00 EGP (13.20/unit)
CELEBREX 200MG 15 CAPS.	PFIZER > VIATRIS EGYPT	198.00 EGP (13.20/unit)

NAPROXEN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg BID with food - short-term

Paediatric dose

Specialist use only for pediatric arthritis

Choice

Alternatives. NICE NG226 advises against paracetamol for osteoarthritis, which leaves the two NSAIDs; naproxen costs 4-11 EGP against celecoxib's 29-198.

Dose source

Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)

Why

Naproxen is an NSAID that inhibits cyclooxygenase to reduce the pain and inflammation of osteoarthritis; among NSAIDs it carries a comparatively favorable cardiovascular risk profile, one reason to favor it here, though the GI risk that all NSAIDs share still needs a co-prescribed PPI.

Cautions

Take with food or milk to minimize GI irritation.
Favorable CV risk profile vs other NSAIDs, but GI risk remains high.
Co-prescribe PPI for gastroprotection.
Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ORGOPROXEN 500 MG 20 TAB.	ORGANOPHARMA > ORGANO	16.00 EGP (0.80/unit)
NAPROSYN 500 MG 10 TAB.	MISR > F.HOFFMAN LA ROCHE	8.05 EGP (0.81/unit)
NAPROFEN 500MG 10 TAB.	EL NILE.	12.00 EGP (1.20/unit)
NAPROFEN 500MG 20 TAB.	EL NILE.	24.00 EGP (1.20/unit)

NON-NSAID OPTION WHEN NSAIDS ARE UNSAFE OR HAVE NOT HELPED

DULOXETINE

Non-NSAID option when NSAIDs are unsafe or have not helped

3rd line

Strength60 mg

Formoral.solid

Adult dose and duration

60 mg once a day, started at 30 mg once a day for one week to let the patient settle on it

Paediatric dose

Not for children - safety and effectiveness in children have not been established, and osteoarthritis is an adult disease.

Dose source

Duloxetine delayed-release capsules US label, section 2.1 Chronic Musculoskeletal Pain (DailyMed SetID 22a8cc15-17fb-4c4e-8d2a-de5755ed6031) - verbatim: "Chronic Musculoskeletal Pain - The recommended dose for Duloxetine Delayed-release Capsules is 60 mg once daily. Dosing may be started at 30 mg for one week, to allow patients to adjust to the medication before increasing to 60 mg once daily."

Why

Every other option listed is paracetamol or an NSAID, so the patient with peptic ulcer, renal impairment, heart failure or anticoagulation has nothing left. Duloxetine acts centrally rather than on the joint and is the option the article names for that gap.

Cautions

Do not give with a monoamine oxidase inhibitor, within 14 days of stopping one, or alongside linezolid, and do not use it in uncontrolled narrow-angle glaucoma.
Avoid it in anyone with chronic liver disease or substantial alcohol use - fatal hepatic failure has been reported; stop the drug if jaundice appears.
Warn about the first weeks: watch for worsening mood or suicidal thinking, particularly in younger adults, and review early. Review the pain benefit before continuing it long-term.
It raises blood pressure and can cause nausea, dry mouth and drowsiness; taper it when stopping, because abrupt withdrawal causes dizziness and paraesthesiae.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DULOPRESSIVE 60 MG 30 CAPS.	GLOBAL NAPI PHARMACEUTICALS > TA PHARMA	174.00 EGP (5.80/unit)
DEPRETREVE 60MG 20 CAPS.	INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA	148.00 EGP (7.40/unit)
DULOXEPRIN 60 MG 28 CAPS.	FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA	214.00 EGP (7.64/unit)
CYMBATEX 60 MG 30 CAPS.	EVA PHARMA	295.50 EGP (9.85/unit)
DUCANDES 60 MG 28 CAPSULES	MASH PREMIERE > INCANDESCE	280.00 EGP (10.00/unit)
CYMBALTA 60 MG 28 CAPS.	ELI LILLY	544.00 EGP (19.43/unit)
DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.	ZETA PHARMA	231.00 EGP
WADILOXTIN 60 MG 28 DEL. REL. CAPS.	WADI ELNEEL BENTA	280.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.