Management of osteoarthritis: ACR/AF latest Guideline
USA: The American College of Rheumatology (ACR) and the Arthritis Foundation (AF) have released 2019 guidelines for the management of osteoarthritis (OA) of the hand, hip, and knee.
Osteoarthritis is the most common form of arthritis, affecting an estimated 302 million people worldwide, and is a leading cause of disability among older adults. The knees, hips, and hands are the most commonly affected appendicular joints.
This guideline, published in the journal Arthritis & Rheumatology, provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision‐making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Recommendations for physical, psychosocial, and mind‐body approaches
- Exercise is strongly recommended for patients with knee, hip, and/or hand OA.
- Balance exercises are conditionally recommended for patients with knee and/or hip OA.
- Weight loss is strongly recommended for patients with knee and/or hip OA who are overweight or obese.
- Self‐efficacy and self‐management programs are strongly recommended for patients with knee, hip, and/or hand OA.
- Tai chi is strongly recommended for patients with knee and/or hip OA.
- Yoga is conditionally recommended for patients with knee OA.
- Cognitive-behavioral therapy (CBT) is conditionally recommended for patients with knee, hip, and/or hand OA.
- Cane use is strongly recommended for patients with knee and/or hip OA in whom disease in 1 or more joints are causing a sufficiently large impact on ambulation, joint stability, or pain to warrant the use of an assistive device.
- Tibiofemoral knee braces are strongly recommended for patients with knee OA in whom disease in 1 or both knees are causing a sufficiently large impact on ambulation, joint stability, or pain to warrant the use of an assistive device, and who are able to tolerate the associated inconvenience and burden associated with bracing.
- Patellofemoral braces are conditionally recommended for patients with patellofemoral knee OA in whom disease in 1 or both knees are causing a sufficiently large impact on ambulation, joint stability, or pain to warrant the use of an assistive device.
- Kinesiotaping is conditionally recommended for patients with knee and/or first CMC joint OA.
- Hand orthoses are strongly recommended for patients with first CMC joint OA.
- Hand orthoses are conditionally recommended for patients with OA in other joints of the hand.
- Modified shoes are conditionally recommended against in patients with knee and/or hip OA.
- Lateral and medial wedged insoles are conditionally recommended against in patients with knee and/or hip OA.
- Acupuncture is conditionally recommended for patients with knee, hip, and/or hand OA.
- Thermal interventions (locally applied heat or cold) are conditionally recommended for patients with knee, hip, and/or hand OA.
- Paraffin, an additional method of heat therapy for the hands is conditionally recommended for patients with hand OA.
- Radiofrequency ablation is conditionally recommended for patients with knee OA.
- Massage therapy is conditionally recommended against in patients with knee and/or hip OA.
- Manual therapy with exercise is conditionally recommended against over exercise alone in patients with knee and/or hip OA.
- Iontophoresis is conditionally recommended against in patients with the first CMC joint OA.
- Pulsed vibration therapy is conditionally recommended against in patients with knee OA.
- Transcutaneous electrical stimulation (TENS) is strongly recommended against in patients with knee and/or hip OA.
Recommendations for the pharmacologic management
- Topical NSAIDs are strongly recommended for patients with knee OA and conditionally recommended for patients with hand OA.
- Topical capsaicin is conditionally recommended for patients with knee OA and conditionally recommended against in patients with hand OA.
- Oral NSAIDs are strongly recommended for patients with knee, hip, and/or hand OA.
- Intraarticular glucocorticoid injections are strongly recommended for patients with knee and/or hip OA and conditionally recommended for patients with hand OA.
- Ultrasound guidance for intraarticular glucocorticoid injection is strongly recommended for injection into hip joints.
- Intraarticular glucocorticoid injections versus other injections are conditionally recommended for patients with knee, hip, and/or hand OA.
- Acetaminophen is conditionally recommended for patients with knee, hip, and/or hand OA.
- Duloxetine is conditionally recommended for patients with knee, hip, and/or hand OA.
- Tramadol is conditionally recommended for patients with knee, hip, and/or OA.
- Non‐tramadol opioids are conditionally recommended against in patients with knee, hand, and/or hip OA with the recognition that they may be used under certain circumstances, particularly when alternatives have been exhausted.
- Colchicine is conditionally recommended against in patients with knee, hip, and/or hand OA.
- Fish oil is conditionally recommended against in patients with knee, hip, and/or hand OA.
- Vitamin D is conditionally recommended against in patients with knee, hip, and/or hand OA.
- Bisphosphonates are strongly recommended against in patients with knee, hip, and/or hand OA.
- Glucosamine is strongly recommended against in patients with knee, hip, and/or hand OA.
- Chondroitin sulfate is strongly recommended against in patients with knee and/or hip OA as are combination products that include glucosamine and chondroitin sulfate, but is conditionally recommended for patients with hand OA.
- Hydroxychloroquine is strongly recommended against in patients with knee, hip, and/or hand OA.
- Methotrexate is strongly recommended against in patients with knee, hip, and/or hand OA.
- Intraarticular hyaluronic acid injections are conditionally recommended against in patients with knee and/or first CMC joint OA and strongly recommended against in patients with hip OA.
- Intraarticular botulinum toxin injections are conditionally recommended against in patients with knee and/or hip OA.
- Prolotherapy is conditionally recommended against in patients with knee and/or hip OA.
- Platelet‐rich plasma treatment is strongly recommended against in patients with knee and/or hip OA.
- Stem cell injections are strongly recommended against in patients with knee and/or hip OA.
- Tumor necrosis factor inhibitors and interleukin‐1 receptor antagonists are strongly recommended against in patients with knee, hip, and/or hand OA.
"2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee," is published in the journal Arthritis & Rheumatology.
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