Osteoarthritis guidelines: a progressive role for topical nonsteroidal anti-inflammatory drugs

Figures & data

Table 1 Topical NSAIDs in clinical treatment guidelines for OA

Guideline	Treatment recommendation
American Academy of Orthopaedic Surgeons, 2008^Citation8	Knee OA: patients with symptomatic knee OA and increased risk for GI adverse events (age 60 years or older, comorbid medical conditions, history of peptic ulcer disease or GI bleeding, and/or concomitant use of corticosteroids or anticoagulants) should receive one of the following analgesics for pain
	• acetaminophen (≤4000 mg/day)
	• topical NSAIDs
	• nonselective oral NSAIDs plus gastroprotective agent
	• COX-2 inhibitors
National Institute for Health and Clinical Excellence, 2008^Citation9	Hand or knee OA: acetaminophen or topical NSAIDs should be considered as first-line pharmacologic therapy after nonpharmacologic therapy. Acetaminophen or topical NSAIDs should be considered ahead of oral NSAIDs, COX-2 inhibitors, or opioids as first-line pharmacologic therapies
American College of Rheumatology, 2012^Citation10	Hand OA: first-line pharmacologic therapy for hand OA should include one or more of the following
	• topical NSAIDs, including trolamine salicylate
	• oral NSAIDs, including COX-2 inhibitors
	• topical capsaicin
	• tramadol
	Knee OA: first-line pharmacologic therapy for knee OA should include one of the following
	• acetaminophen
	• topical NSAIDs
	• oral NSAIDs
	• tramadol
	• intra-articular corticosteroid injections
	Patients aged 75 years or older with hand or knee OA should receive topical rather than oral NSAIDs

Abbreviations: COX, cyclooxygenase; GI, gastrointestinal; NSAID, nonsteroidal anti-inflammatory drug; OA, osteoarthritis.

American Academy of Orthopaedic SurgeonsTreatment of Osteoarthritis of the Knee (Non-Arthroplasty)Rosemont, ILAmerican Academy of Orthopaedic Surgeons2008

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National Collaborating Centre for Chronic ConditionsOsteoarthritis: National Clinical Guideline for Care and Management in AdultsLondonRoyal College of Physicians2008 Available from: http://www.nice.org.uk/nicemedia/pdf/CG059FullGuideline.pdfAccessed July 18, 2011

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HochbergMCAltmanRDAprilKTAmerican College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and kneeArthritis Care Res (Hoboken)201264446547422563589

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