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