Topical Treatments
Topical NSAIDs should be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated.

Rationale

Twelve high quality studies (Baer 2005, Roth 2004, Conaghan 2013, Simon 2009, Kneer 2013, Rother 2013, Bookman 2004, Wadsworth 2016, Sandelin 1997, Dehghan 2019, Dehghan 2020, Rother 2007) and two moderate quality studies (Barthel 2009, Ottillinger 2001) show that topical NSAIDs could result in improved function and quality of life over placebo gel. However, inconsistent evidence suggests no significant difference in pain and adverse events between topical NSAIDs and control.

Benefits/Harms of Implementation
Topical NSAIDs are now available over the counter for patients to buy and use. Topical NSAIDs should be used with caution in certain health conditions such as stage 4-5 chronic kidney disease, coronary artery disease, and congestive heart failure. There is a risk for skin sensitivity.

Outcome Importance
Improved function and quality of life improvement are the important outcomes from Topical NSAID use.

Cost Effectiveness/Resource Utilization
Since this will now be available over the counter, prescription coverage will be less. This could pose as a barrier to those without health savings accounts or without insurance. Also, patients might not be willing to apply a topical gel multiple times a day.

Acceptability
The use of a topical gel for osteoarthritis of the knee should be an acceptable method of treatment if cost is not prohibitive and the patient does not have any skin irritation from the gel.

Feasibility
Topical NSAIDs will be available at pharmacies over the counter. The main barrier will be cost and having to apply the gel multiple times a day.

Future Research
Future research might be directed at determining if continued topical NSAID use is required to sustain
benefits or if benefits continue after usage for a defined period of time.