Final set of 10 recommendations based on both evidence and expert opinion
| 1 | The optimal management of knee OA requires a combination of non-pharmacological and pharmacological treatment modalities |
| 2 | The treatment of knee OA should be tailored according to: |
| (a) Knee risk factors (obesity, adverse mechanical factors, physical activity) | |
| (b) General risk factors (age, comorbidity, polypharmacy) | |
| (c) Level of pain intensity and disability | |
| (d) Sign of inflammation—for example, effusion | |
| (e) Location and degree of structural damage | |
| 3 | Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction |
| 4 | Paracetamol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic |
| 5 | Topical applications (NSAID, capsaicin) have clinical efficacy and are safe |
| 6 | NSAIDs should be considered in patients unresponsive to paracetamol. In patients with an increased gastrointestinal risk, non-selective NSAIDs and effective gastroprotective agents, or selective COX 2 inhibitors should be used |
| 7 | Opioid analgesics, with or without paracetamol, are useful alternatives in patients in whom NSAIDs, including COX 2 selective inhibitors, are contraindicated, ineffective, and/or poorly tolerated |
| 8 | SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) have symptomatic effects and may modify structure |
| 9 | Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion |
| 10 | Joint replacement has to be considered in patients with radiographic evidence of knee OA who have refractory pain and disability |