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Table 6 Guideline recommendations for medication

From: A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

  AAOS [10] EULAR [6] ICSI [9] Schnitzer/ACR [7] CCC [8]
Nonselective NSAID Recommended (A) Recommended (A) Recommended if acetaminophen not effective Recommended Recommended (A)
   Recommended with PPI if gastrointestinal risk factors   Recommended with PPI or misoprol if gastrointestinal risk factors Recommended (A) with PPI if gastrointestinal risk factors
     Use with caution for patients with high risk factors for congestive heart failure or renal problems Use with caution with elderly patients (C) or patients with renal problems (D)
     Not recommended for patients on anticoagulation therapy or preoperative period  
Topical NSAID   Recommended (A)    Recommended (A)
Acetaminophen Recommended (A) Recommended (A) as initial pain treatment Recommended as initial pain treatment Recommended as initial pain treatment Recommended (A) as initial pain treatment
Coxibs Recommended (B) if renal or gastrointestinal risk factors Recommended (A) if gastrointestinal risk factors Recommended if gastrointestinal risk factors Recommended for patients not responding to acetaminophen or nonpharmacologic modalities Recommended (A) if gastrointestinal risk factors, depending on cardiovascular risks
     Recommended for patients with severe pain or signs of inflammation Use with caution with elderly patients (C) or patients with renal problems (D)
     Recommended for patients with high gastrointestinal risks.  
     Use with caution for patients with high risk factors for congestive heart failure or renal problems  
Tramadol     Recommended for patients with contraindication to NSAIDs/coxibs or who have not responded to oral therapy  
Opioids   Recommended (B) if NSAIDs are contraindicated Recommended if NSAIDs contraindicated and if nonpharmacologic treatments not effective Recommended for patients who have not responded to tramadol or have side effects  
Capsaicin   Recommended (A)   Recommended as an adjunct treatment to oral therapy, for patients with contraindication to NSAIDs/coxibs or for patients who have not responded to oral therapy  
Nonacetylated salicylates     Recommended  
Methylsalicylate     Recommended as an adjunct treatment to oral therapy, for patients with contraindication to NSAIDs/coxibs or for patients who have not responded to oral therapy  
  1. AAOS, American Academy of Orthopaedic Surgeons; ACR, American College of Rheumatology; CCC, Canadian Consensus Conference; EULAR, European League Against Rheumatism; ICSI, Institute for Clinical Systems Improvement; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.