OARSI guidelines for hip and knee OA: deciphering the topical drug melange

摘要

I am confused by the evidence for topical non-steroidal antiinflammatory drugs (NSAIDs) to treat knee osteoarthritis (OA) pain, presented by Zhang et a in General Recommendation 15, "Topical NSAIDs and capsaicin...", of the new OARSI guidelines. Given the authors' widely-supported preference for evidence-based conclusions derived wherever possible from randomized controlled trials (RCTs), it is surprising that they too grouped these two very different pharmaceutical substances and assigned them the same level (LoE) and strength of evidence rating (SOR), citing different quantity and quality of published data for each_and noting that "adequate blinding is not possible in trials with this agent [capsaicin]".