provide new information on the efficacy or safety/tolerability of existing modalities. Selected key articles that were used to generate the evidence profiles for each of the nonpharmacologic and pharmacologic modalities are listed in Supplementary Appendix B (available in the online version of this article at http://onlinelibrary.wiley. com/journal/10.1002/(ISSN)2151-4658). In the second quarter of 2011, the TEP reviewed the information obtained from the updated literature search and voted electronically on the need for making any changes in the original recommendations as well as providing recommendations for any new therapeutic modalities. Conference calls were conducted in order to reach consensus, as necessary. These updated votes are included in the recommendations in this manuscript. Following manuscript development, a draft was submitted to the ACR Guideline Subcommittee, ACR Quality of Care Committee, and ACR Board of Directors for their comments and votes in regard to approval. These comments were incorporated into the final recommendations to the extent possible. An adult with symptomatic hand OA without cardiovascular comorbidities, current or past upper GI problems, or chronic kidney disease presents to her primary care provider for treatment. She has pain in several finger joints for several months. Over-the-counter (OTC) acetaminophen at dosages up to 3 gm/day was of minimal value. Radiographs revealed osteophytes at several distal and proximal interphalangeal joints with joint space narrowing but no erosions. The evidence base for hand OA was developed in collaboration with one of the authors (TT); this report has subsequently been published in part (24). There were relatively few high-quality RCTs of interventions for hand OA published in the peer-reviewed literature. Therefore, there were no strong recommendations made by the TEP for this indication. There are, however, several conditional recommendations that are discussed in the following sections. The TEP conditionally recommends that all patients with hand OA should be evaluated by a health professional, either their primary care provider or an occupational or physical therapist, for their ability to perform activities of daily living and receive assistive devices as necessary, instruction in joint protection techniques, and the use of thermal agents for relief of pain and stiffness (Table 1). The TEP conditionally recommends that patients with OA involving the trapeziometacarpal joint should be provided with splints, as they may benefit from this device. No strong recommendations were made for the nonpharmacologic management of hand osteoarthritis (OA). The evidence supporting these interventions demonstrated only a small to moderate effect size (see supplementary bibliography for hand OA in Supplementary Appendix B, available in the online version of this article The TEP conditionally recommends that patients with hand OA should be treated with either topical or oral NSAIDs, topical capsaicin, or tramadol (Table 2). The TEP conditionally recommends that such patients not be treated with opioid analgesics or intraarticular therapies. We conditionally recommend that persons age ≥75 years should use topical rather than oral NSAIDs. In persons age <75 years, the TEP expressed no preference for using topical rather than oral NSAIDs. No strong recommendations were made for the pharmacologic management of hand osteoarthritis (OA). For patients who have