Topical capsaicin (Zostrix) and tramadol (Ultram) are also conditionally recommended. PHARMACOLOGICĬonditional recommendations for the initial pharmacologic management of hand osteoarthritis include oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as cyclo-oxygenase-2 selective inhibitors, and topical NSAIDs (e.g., trolamine salicylate). In addition, patients should be instructed in the use of thermal modalities and other techniques that help protect their joints, including splints for patients who have osteoarthritis of the trapeziometacarpal joint. The ACR conditionally recommends that physicians evaluate a patient's ability to perform activities of daily living and provide assistive devices to help patients perform these activities, if needed. Recommendations for Osteoarthritis of the Hand NONPHARMACOLOGIC A conditional recommendation indicates that although most informed patients would choose the recommended therapy, many would not therefore, physicians should ensure that the care they recommend is in keeping with their patients' values and preferences. A strong recommendation indicates that most patients, when informed of the quality of the evidence supporting the use of a therapy and the degree to which its benefits outweigh its harms, would choose the recommended therapy, and that physicians may structure their interactions with patients accordingly. These recommendations are categorized as strong or conditional. The American College of Rheumatology (ACR) has released updated recommendations for the treatment of osteoarthritis of the hip and knee, and has developed new recommendations for the treatment of osteoarthritis of the hand. Published source: Arthritis Care & Research, April 2012 Guideline developed by participants without relevant financial ties to industry? No Guideline source: American College of Rheumatology