Background: The pain of osteoarthritis (OA) is disabling and is the main reason patients seek health care. Oral analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 inhibitors (COX2-I) and paracetamol, can cause multiple side effects, especially in the elderly with OA.

Objectives: The main objective of this study was to identify reasons for frequent oral analgesic (NSAIDS/COX2I/paracetamol) use and to examine any treatment related risk factors, and OA related knowledge/beliefs, associated with this drug use behavior in a cohort of patients with OA.

Methods: This cross-sectional descriptive study was conducted at the rheumatology clinics of the National Hospital of Sri Lanka. 400 patients diagnosed with lower limb OA using American College of Rheumatology (ACR) criteria were included. Data collection was by a structured, interviewer-administered questionnaire developed for this study. This questionnaire examined the demographics, disease related information, use of analgesics and as well as the OA knowledge scale (OAKS) domains translated to Sri Lankan native languages. Chi square tests at (p<0.05) were used to examine associations between increased analgesic use and risk factors.

Results: The study population was mainly female (91.2%) with a mean age and body mass index of 61.6 (SD 9.1) years and 27.1 (SD 4.1). The average duration of disease was 8.5 (SD 7.8) years and the dominant joint involved was knee (98%). Eighty persons (20% of the study population) used oral analgesics for pain relief on more >15 days per month. Persons with poor response to core therapy (87% vs 13%); those with little time for non-pharmacological therapies (59% vs 41%); and persons not using lifestyle (35% vs 65%)/home modifications (76% vs 23%) for OA were significantly more likely to use analgesics for longer periods. Those doing regular physical activity used significantly lower amounts of pain relief (75% vs 20%). In contrast, this significant association was not seen in those not adhering to a healthy diet (81% vs 19%). The following beliefs/statements related to knowledge on OA/or its treatment (assessed by the OAKS) were significantly associated with reduced analgesic use: belief that regular exercise alleviates pain (69% vs 31%), that maintaining healthy body weight is important in OA (74% vs 26%) and knowing that exercise/physical activity as equally effective as medication (84% vs 16%)).

Conclusion: High numbers of persons used pain relief for more than fifteen days per month. Reliance on analgesics was linked to unsatisfactory response to core therapies, lack of engagement with lifestyle/home modifications and reduced physical activity. Correct beliefs about osteoarthritis, understanding the importance of lifestyle interventions, were associated with a decreased analgesic use. These findings indicate that healthcare providers must improve the understanding/knowledge of osteoarthritis and promote non-pharmacological strategies to reduce patient reliance on analgesics.

REFERENCES: [1] Darlow, B. et al. The osteoarthritis knowledge scale. Musculoskeletal Care 21, 516-526, doi:10.1002/msc.1727 (2023).

Acknowledgements: NIL.

Disclosure of Interests: Inoshi Atukorala: None declared, Madusha Rajapaksha: None declared, Induwara Atapattu: None declared, Chathumi Dassanayake: None declared, Arunasalam Pathmeswaran: None declared, Jocelyn Bowden Dr Bowden is supported by an unrestricted fellowship from Haleon Australia, which has no relationship to this project, Monika De Silva: None declared, Gunendrika Kasthuriratna: None declared, Ushagowry Saravanamuttu: None declared, Indika Kulasinghe: None declared, David Hunter Scientific advisory boards for Haleon, TLC Bio, Novartis,Tissuegene, Biobone, Sanofi, Enlivex.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.