{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:31:19Z","timestamp":1786422679290,"version":"build-2736575974"},"reference-count":85,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Non-steroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of pharmacological treatment for osteoarthritis (OA) and are recommended by international guidelines for the management of symptomatic pain. Despite their well-established efficacy, substantial interindividual variability exists in treatment response, with some patients experiencing meaningful pain relief while others derive little clinical benefit despite appropriate drug selection and dosing. This variability reflects, at least in part, the biological heterogeneity of OA pain. Objective: To review the mechanisms underlying variability in NSAID responsiveness in OA and to propose a practical framework for personalized NSAID prescribing based on pain phenotype, individual safety profile, and treatment timing. Methods: A narrative review of the contemporary scientific literature was conducted using major biomedical databases to summarize the current evidence on phenotype-guided NSAID therapy in OA. Particular attention was given to the emerging concepts of nociceptive, nociplastic, and neuropathic-like pain phenotypes and their implications for personalized anti-inflammatory therapy. Results: Current evidence indicates that OA pain is a heterogeneous and dynamic condition in which inflammatory nociceptive, nociplastic, and neuropathic-like mechanisms coexist to varying degrees. NSAIDs primarily target inflammatory nociceptive pain by inhibiting cyclooxygenase (COX)-mediated prostaglandin synthesis and reducing peripheral sensitization. Consequently, patients with predominantly inflammatory nociceptive pain are the most likely to benefit from NSAID therapy, whereas those with predominant nociplastic or neuropathic-like pain mechanisms may require alternative or multimodal treatment strategies. Beyond pain phenotype, optimal NSAID selection should integrate cardiovascular, gastrointestinal, and renal risk assessment, recognizing the important pharmacological and safety differences among individual agents. Treatment timing is also clinically relevant, as anti-inflammatory therapy appears most effective when initiated during periods of active inflammatory nociceptive pain. Based on the available evidence, we propose a conceptual clinical decision framework integrating patient selection, NSAID choice, and treatment timing. Conclusions: Personalized NSAID prescribing should move beyond a diagnosis-based approach toward a mechanism-based strategy that integrates pain phenotyping, individualized safety assessment, and appropriate treatment timing. The proposed framework is built upon three complementary principles, identifying the right patient, selecting the right treatment, and initiating therapy at the right time. It provides a practical foundation for implementing precision medicine in the pharmacological management of OA.<\/jats:p>","DOI":"10.3390\/life16081303","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:20:03Z","timestamp":1786324803000},"page":"1303","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward Personalized NSAID Therapy in Osteoarthritis: The Right Patient, the Right Treatment, at the Right Time"],"prefix":"10.3390","volume":"16","author":[{"given":"Valerica Creanga","family":"Zarnescu","sequence":"first","affiliation":[{"name":"The School for Doctoral Studies in Biomedical Sciences, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Center of Physical Therapy, Rehabilitation and Wellness, \u201cDun\u0103rea de Jos\u201d University of Galati, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7983-3811","authenticated-orcid":false,"given":"Liliana","family":"Mititelu-Tartau","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700454 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1003-0719","authenticated-orcid":false,"given":"Ilie","family":"Onu","sequence":"additional","affiliation":[{"name":"Center of Physical Therapy, Rehabilitation and Wellness, \u201cDun\u0103rea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700454 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6422-2030","authenticated-orcid":false,"given":"Daniel Andrei","family":"Iordan","sequence":"additional","affiliation":[{"name":"Center of Physical Therapy, Rehabilitation and Wellness, \u201cDun\u0103rea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"Department of Individual Sports and Kinetotherapy, Faculty of Physical Education and Sport, Dunarea de Jos University of Galati, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana-L\u0103cr\u0103mioara","family":"Pavel","sequence":"additional","affiliation":[{"name":"Medical Department, Faculty of Medicine and Pharmacy, \u201cDunarea de Jos\u201c University of Galati, 800010 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100433","DOI":"10.1016\/j.ocarto.2023.100433","article-title":"Pain-phenotyping in osteoarthritis: Current concepts, evidence, and considerations towards a comprehensive framework for assessment and treatment","volume":"6","author":"Saxer","year":"2024","journal-title":"Osteoarthr. 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