an inadequate response to initial pharmacologic management, please see the Results for alternative strategies. NSAIDs = nonsteroidal antiinflammatory drugs; COX-2 = cyclooxygenase 2; TEP = Technical Expert Panel. For patients with involvement of the trapeziometacarpal joint who request an intraarticular injection, the TEP conditionally recommends not using either intraarticular corticosteroids or hyaluronates and, furthermore, provided no recommendation on the choice between corticosteroids and hyaluronates, if a provider decides to give an injection. For patients with erosive and/or inflammatory interphalangeal OA, the TEP conditionally recommends not using either oral methotrexate or sulfasalazine and voted not to provide a recommendation either for or against the use of hydroxychloroquine. The recommendations not to use modalities were based largely on the absence of evidence from RCTs to support the benefits of use of these modalities and the potential for harm from these agents and/or procedures. An adult with symptomatic knee OA without cardiovascular comorbidities, current or past upper GI problems, or chronic kidney disease presents to her primary care provider for treatment. She experiences pain in and/or around her knee(s) and has not had an adequate response to either intermittent dosing of OTC acetaminophen, OTC NSAIDs, or OTC nutritional supplements (e.g., chondroitin sulfate, glucosamine). The TEP strongly recommends that all patients with symptomatic knee OA be enrolled in an exercise program commensurate with their ability to perform these activities (25, 26) (Table 3). The TEP expressed no preference for aquatic exercises as opposed to land-based exercises based on benefits or safety; the decision should be individualized and based on patient preferences and ability to perform exercises. For example, a patient who is aerobically deconditioned should initially participate in an aquatic exercise program in order to improve their aerobic capacity. Once this is accomplished, they can progress to a land-based program and choose, in conjunction with their health care provider, an aerobic conditioning or strengthening program or both. The TEP also strongly recommends that all patients with symptomatic knee OA who are overweight be counseled regarding weight loss (27). These modalities are conditionally recommended only when the patient with knee osteoarthritis (OA) has chronic moderate to severe pain and is a candidate for total knee arthroplasty but either is unwilling to undergo the procedure, has comorbid medical conditions, or is taking concomitant medications that lead to a relative or absolute contraindication to surgery or a decision by the surgeon not to recommend the procedure. The TEP conditionally recommends that patients with knee OA should 1) participate in self-management programs that may include psychosocial interventions, 2) use thermal agents and manual therapy in combination with exercise supervised by a physical therapist, 3) use medially directed patellar taping, 4) participate in tai chi programs, and 5) use walking aids, if necessary. Patients with lateral compartment OA are conditionally recommended to wear medially wedged insoles, while those with medial compartment OA are conditionally recommended to wear laterally wedged subtalar strapped insoles. For the base case failing to obtain adequate pain relief with intermittent dosing of OTC