Topical agents: The most widely used preparations contain capsaicin, lidocaine and NSAIDs
These preparations have been shown to be efficacious in controlled double-blind studies of OA of the hand and knee (minimal overlying soft tissue).
Note: Some of the topical NSAIDs are as efficacious as oral NSAIDs (lower incidence GI side effects).
*Consider in older patient with OA of hand or knee*
Oral agents: Acetaminophen is still considered first line treatment for mild to moderate pain. It has a small but significant effect for pain but this did not carry over for stiffness or functional improvement.
NSAIDs: More efficacious than acetaminophen for pain. Consider first line for moderate to severe pain.
While all attempts should be made at avoiding NSAIDs in patients at risk of upper GI bleeding, the safest approach may be to use Celecoxib with a proton pump inhibitor.
References
Chronic OA Management, Marc C. Hochberg. Volume 3 December 2013
