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Differential Diagnosis of Joint Pain and Appropriate Choice of Pain Killer in the Elderly
Korean J Clin Geri 2018 Jun;19(1):9-15
Published online June 30, 2018;
Copyright © 2018 The Korean Academy of Clinical Geriatrics.

Hye-Jin Jeong, Sang-Hyon Kim

Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
Received May 21, 2018; Revised June 15, 2018; Accepted June 19, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
In Korea, the prevalence of joint disease among chronic diseases of the elderly is increasing as it enters the aging society. Therefore, appropriate differential diagnosis should be made when a patient complains of joint symptoms. Depending on the position of the joint itself or the surrounding structures, it is possible to distinguish the cause of joint symptoms. We can also make a differential diagnosis based on the range and distribution of joints, the number of joints with symptoms, the duration of symptoms, and the pattern of pain. In order to improve joint symptoms, the first agent to use is analgesic, which is very diverse, therefore important to take according to proper prescription. The types of analgesic drugs are classified into non-opioid and opioid analgesics. Among non-opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used when the arthralgia is not controlled by acetaminophen. However, a variety of side effects, such as nephrotoxicity and gastrointestinal toxicity of NSAIDs, should be noted for elderly patients. Opioid agents have the advantage of increasing the analgesic effect in proportion to the dose, however, there are several side effects including nausea, vomiting, sedation, respiratory depression, and constipation. Because of the characteristics of the elderly population, it is difficult to predict the appropriate dose, concentration and side effects of the drugs; further there is a lack of guidance on these drugs. When using analgesics for the treatment of arthralgia, we should try to understand the characteristics of the elderly and choose the safest and most effective drugs.
Keywords : Arthralgia, Analgesics, Elderly
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December 2018, 19 (2)