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ACR and Arthritis Foundation Release Updated Guideline on Osteoarthritis Management

The American College of Rheumatology (ACR) and the Arthritis Foundation have released a guideline for the management of hand, hip, and knee osteoarthritis (OA).1 The guideline—which is an update of the 2012 ACR recommendations on the use of nonpharmacologic and pharmacologic therapies in hand, hip, and knee OA—includes recommendations on how to comprehensively manage OA.

The ACR and the Arthritis Foundation released a preview of the updated guideline at the 2019 ACR/Association of Rheumatology Professionals Annual Meeting.

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“The new guideline recognizes not only the variety of clinical presentations of OA, but also the broad array of treatment options available,” Sharon Kolasinski, MD, a professor of clinical medicine at the University of Pennsylvania, and lead author on the updated practice guideline for OA, said in a press release.2 “Clinicians and patients can choose from educational, behavioral, psychosocial, mind-body, physical and pharmacological approaches. It’s important to remember that treatment for OA is not one size fits all.”

The recommendations were developed based on a review of literature that summarized evidence on the benefits and harms of the available approaches for OA management. The voting panel that achieved consensus on the recommendations comprised rheumatologists, an internist, physical and occupational therapists, and patients.

After assessing the benefit, safety, and tolerability of physical, educational, behavioral, psychosocial, mind‐body, and pharmacologic interventions, the guideline authors made the following strong recommendations for patients with knee, hip, and/or hand OA:

  • Encourage patients to exercise—especially those with knee and hip OA.
  • Have patients engage in self‐efficacy and self‐management programs.

 

The following strong recommendations were made for patients with knee and/or hip OA:

  • Encourage patients who are overweight or have obesity to lose weight.
  • Have patients practice tai chi.
  • Instruct patients to use a cane if disease in 1 or more joints is causing a sufficiently large impact on ambulation, joint stability, or pain to warrant use of an assistive device.
  • Do not prescribe transcutaneous electrical stimulation (TENS).
  • Administer intraarticular glucocorticoid injections (this is a conditional recommendation for patients with hand OA).

 

The guideline authors also make the strong recommendation for clinicians to prescribe topical nonsteroidal anti-inflammatory drugs (NSAIDs) to patients with knee OA, although the recommendation is conditional for patients with hand OA.

Recommendations on hand orthoses for first carpometacarpal joint OA, tibiofemoral bracing for tibiofemoral knee OA, oral NSAIDs, balance exercises, yoga, cognitive behavioral therapy, acupuncture, thermal modalities, and more were also developed.

The recommendations also include suggestions against the use of bisphosphonates, hydroxychloroquine, methotrexate, platelet-rich plasma and stem cell injections (in hip and knee OA), tumor necrosis factor inhibitors, and interleukin-1 receptor antagonists.

“A number of agents have been tested and fail to show adequate benefit to justify their use, while others will require additional investigations to clarify their place in the OA armamentarium,” Dr Kolasinski said. “The recommendations against usage of these therapies reflects the fact that pharmacologic options remain limited for the management of OA. A broad suggested research agenda is outlined in the guideline to address this gap.”

—Colleen Murphy

References:

  1. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee [published online January 6, 2020]. Arthritis Rheumatol. doi:10.1002/art.41142.
  2. American College of Rheumatology/Arthritis Foundation release updated treatment guideline for osteoarthritis [press release]. Atlanta, GA: American College of Rheumatology; January 7, 2020. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1078. Accessed January 8, 2020.