A 45-year-old woman with osteoarthritis is considering NSAIDs for pain control. She has mild dyspepsia and hypertension. Which NSAID strategy is most appropriate?

• A. Naproxen 250 mg twice daily with a proton pump inhibitor
• B. Ibuprofen 400 mg three times daily without additional measures
• C. Diclofenac 50 mg twice daily alone
• D. Celecoxib 200 mg daily without GI protection

Answer: (A)

When using NSAIDs in someone with osteoarthritis who has mild dyspepsia and hypertension, the aim is to relieve pain while minimizing GI and cardiovascular risks. NSAIDs can irritate the stomach and increase the risk of ulcers or bleeding, especially in someone with dyspepsia. Protecting the stomach with a proton pump inhibitor lowers that risk without negating the pain relief NSAIDs provide. Among NSAIDs, naproxen at a low dose is effective for OA and is associated with a comparatively favorable cardiovascular safety profile. So pairing a low-dose naproxen with a proton pump inhibitor offers analgesia while reducing GI injury, which is why this option is the most appropriate. The other strategies either omit GI protection, which raises GI risk, or rely on a COX-2 inhibitor without GI protection and with potential cardiovascular concerns in a person with hypertension.