Non-NSAID Topical Creams for Knee Arthritis

First-Line Non-NSAID Topical Option: Capsaicin

The American College of Physicians recommends topical capsaicin cream (0.025% to 0.075%) as the primary non-NSAID topical option for knee osteoarthritis, available over-the-counter, though it requires continuous application 3-4 times daily for 2-4 weeks before therapeutic effect occurs 1, 2
Capsaicin is specifically recommended for knee osteoarthritis pain management and demonstrates moderate efficacy with a standard mean difference of 0.44 in reducing pain 2

Initial burning or stinging occurs in 35-100% of patients using capsaicin, but typically peaks in week 1 and declines rapidly thereafter 2

Intra-articular corticosteroid injections are effective for short-term pain relief, particularly for acute flares with effusion 1, 4, 5
Acetaminophen up to 3000-4000 mg daily remains the safest systemic option before considering oral NSAIDs 5

Exercise therapy including joint-specific strengthening and general aerobic conditioning must accompany any pharmacologic management and should be implemented before escalating treatments 5

Do not recommend capsaicin for hip osteoarthritis - evidence is insufficient given the depth of the hip joint 1, 2
Do not recommend glucosamine or chondroitin - current evidence does not support their efficacy 4, 5