Table 6

Final set of 10 recommendations based on both evidence and expert opinion

1The optimal management of knee OA requires a combination of non-pharmacological and pharmacological treatment modalities
2The 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
3Non-pharmacological treatment of knee OA should include regular education, exercise, appliances (sticks, insoles, knee bracing), and weight reduction
4Paracetamol is the oral analgesic to try first and, if successful, the preferred long term oral analgesic
5Topical applications (NSAID, capsaicin) have clinical efficacy and are safe
6NSAIDs 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
7Opioid 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
8SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) have symptomatic effects and may modify structure
9Intra-articular injection of long acting corticosteroid is indicated for flare of knee pain, especially if accompanied by effusion
10Joint replacement has to be considered in patients with radiographic evidence of knee OA who have refractory pain and disability