What are the ACR/Arthritis Foundation recommendations on pharmacotherapy for the treatment of knee osteoarthritis?

Updated: Oct 12, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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For pharmacologic treatment of knee osteoarthritis, the ACR/Arthritis Foundation guidelines strongly recommend the following [154]

  • Topical NSAIDs; should be considered prior to use of oral NSAIDs
  • Oral NSAIDs; however, doses should be as low as possible and treatment should be as short as possible
  • Intra-articular glucocorticoid injections

Conditionally recommended agents include the following [154] :

  • Topical capsaicin
  • Acetaminophen
  • Duloxetine
  • Tramadol

The ACR/Arthritis Foundation guidelines conditionally recommend against use of the following for knee osteoarthritis:

  • Non‐tramadol opioids (with the recognition that they may be used under certain circumstances, particularly when alternatives have been exhausted)
  • Intra-articular hyaluronic acid injections
  • Intra-articular botulinum toxin injections
  • Colchicine
  • Fish oil
  • Vitamin D
  • Prolotherapy

The ACR/Arthritis Foundation guidelines strongly recommend against use of the following for knee osteoarthritis:

  • Platelet‐rich plasma treatment
  • Stem cell injections
  • Bisphosphonates
  • Glucosamine
  • Chondroitin sulfate
  • Hydroxychloroquine
  • Methotrexate
  • Tumor necrosis factor inhibitors and interleukin‐1 receptor antagonists

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