Treatment options for patients with advanced osteoarthritis who decline knee surgery

Table 1 International guidelines comparison for non-surgical knee osteoarthritis treatment

Domain	EULAR/ESCEO	ACR	OARSI	AAOS	NICE
Exercise	+++	+++	+++	+++	+++
Weight management	+++	+++	+++	++	+++
Topical NSAIDs	+++	+++	+++	+++	+++
Oral NSAIDs	+++	+++	++	+++	++
Acetaminophen	+	++	-	+++	+
Intra-articular corticosteroids	+	+++	++	++	++
Intra-articular hyaluronic acid	+	-	++	-	-
Opioids1	+	++	--	--	+
Duloxetine	+	++	+	ND	ND
Supplementation	++	--	-	+	--
Bracing	+	++	-	+	+

¹Among opioids guidelines often make a distinction between tramadol and other opioids. If this distinction is made the recommendation for tramadol is applied.

+++: Strong recommendation; ++: Conditional recommendation; +: Weak recommendation, -: Conditional recommendation against; --: Strongly recommended against; ND: Not defined; EULAR: European Alliance of Associations for Rheumatology; ESCEO: Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases; ACR: American College of Rheumatology; OARSI: Osteoarthritis Research Society International; AAOS: American Academy of Orthopedic Surgeons; NICE: United Kingdom’s National Institute for Health and Care Excellence; NSAID: Non-steroidal anti-inflammatory drugs.