American Association of Orthopaedic Surgeons (AAOS) 2013 [33]
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• Knee OA: Strongly recommend oral or topical NSAIDs or tramadol for the pharmacologic management of patients with symptomatic OA of the knee
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American College of Rheumatology (ACR) 2012 [9]
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• Hand OA: Initial management of hand OA should include one
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• or more of the following:
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o topical capsaicin
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o topical NSAIDs, including trolamine salicylate
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o oral NSAIDs, including COX-2 inhibitors
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o tramadol
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• Knee OA: Initial management of knee OA should include one
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• of the following:
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o acetaminophen
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o oral NSAIDs
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o topical NSAIDs
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o tramadol
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o intra-articular corticosteroid injections
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• Topical rather than oral NSAIDs should be used in patients with hand or knee OA aged ≥75 years
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American Geriatric Society (AGS) 2009 [35]
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• Localized, non-neuropathic persistent pain: Patients with localized, non-neuropathic persistent pain may be candidates for topical NSAIDs
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American Pain Society (APS) 2002 [34]
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• Guidelines were published prior to FDA approval of topical NSAIDs
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European League Against Rheumatism (EULAR) 2003, 2007 [10, 36]
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• Hand OA: Topical treatments are recommended over systemic treatments, especially for mild to moderate pain and when only a few joints are affected
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• Hand or Knee OA: Topical NSAIDs and capsaicin have clinical efficacy and are safe in the treatment of hand or knee OA
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National Institute for Health and Clinical Excellence (NICE, United Kingdom) 2008 [11]
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• Hand or Knee OA:
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o Topical NSAIDs should be considered for pain relief in addition to nonpharmacologic treatment
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o Topical NSAIDs and/or acetaminophen should be considered ahead of oral NSAIDs, COX-2 inhibitors, or opioids
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Osteoarthritis Research Society International (OARSI) 2008 [12]
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• Knee OA: Topical NSAIDs and capsaicin may be effective as adjunctives and alternatives to oral analgesics/anti-inflammatory agents in patients with knee OA
|