title: Treatments for osteoarthritis should include the use of topical NSAIDs.
abstract: Of the core treatments mentioned in the NICE guidelines, only exercise therapy is said to be effective in treating osteoarthritis. However, many patients do not adhere to long-term exercise programmes. The use of topical NSAIDs is preferable to pharmacological treatment for hand and knee osteoarthritis and the guidelines should emphasise this. The guidelines do not recommend glucosamine sulphate although it has been shown to be beneficial for knee osteoarthritis and has an excellent safety record. They suggest that factors such as smoking, obesity and comorbidities should not be a bar to consideration of surgical joint replacement, but it is uncertain to what extent this will lead to perioperative complications.