Duloxetine for Managing Painful Knee or Hip Osteoarthritis?

Duloxetine (Cymbalta and generics) is a serotonin and norepinephrine reuptake inhibitor that was originally developed to treat patients with depression. However, it can mitigate pain through centrally acting mechanisms and is U.S. FDA-approved for treating “chronic musculoskeletal pain.” The American College of Rheumatology recommends duloxetine “conditionally” as an option for patients with painful osteoarthritis (OA; Arthritis Rheumatol 2020; 72:220), but its effectiveness in typical primary care settings is unclear. In this trial involving 133 patients with painful knee or hip OA, primary care practices were randomized to provide either usual care alone or usual care plus duloxetine (initially 30 mg daily, titrated to 60 mg after 1 week …