ACR Releases Foundation Guideline for Osteoarthritis Management

The American College of Rheumatology (ACR), in conjunction with the Arthritis Foundation, published an updated evidence-based guideline for the comprehensive management of osteoarthritis (OA) of the hand, hip, and knee.

“As OA spans decades of a patient’s life, patients with OA are likely to be treated with a number of different pharmaceutical and nonpharmaceutical interventions, often in combination,” according to the report, which was published in Arthritis & Rheumatology. “This report provides recommendations to guide patients and clinicians in choosing among the available treatments.”

To form the new guideline, the research team sought population, intervention, comparator, outcomes questions, and critical outcomes relevant to OA. A systematic literature review was conducted to gather data on educational, behavioral, psychosocial, physical, mind‐body, and pharmacologic OA therapies.

The research team made strong or conditional recommendations pertaining to the current available evidence.

Osteoarthritis Do’s and Dont’s Exercise, NSAIDs Are In; TENS, Methotrexate Are Out

Regarding physical, psychosocial, and mind-body approaches to treat hip and knee OA, the team strongly recommended against the use of transcutaneous electrical nerve stimulation (TENS), and they conditionally recommended against manual (with or without exercise) and massage therapies, modified shoes, and weighted insoles; for knee OA, they conditionally recommended against pulsed vibration therapy, and for hand OA, iontophoresis.

Physical, psychosocial, and mind-body approaches the team strongly recommended for hand, knee, and hip OA were exercise and self-efficacy and self-management programs. Certain exercises were more favorable for different joints; for instance, tai chi is strongly recommended in the treatment of hip and knee OA, while yoga is conditionally recommended for knee OA patients. Strong recommendations were made for weight loss and the use of a cane for hip and knee OA patients. Conditional recommendations for all three joints were made for heat and therapeutic healing, cognitive behavioral therapy, and acupuncture.

Regarding pharmacologic approaches, the guidelines strongly recommend against the use of bisphosphonates, glucosamine, hydroxychloroquine, methotrexate, TNF inhibitors, and IL-1 receptor antagonists for all three joints. PRP, stem cell injection, and chondroitin are strongly recommended against for knee and hip OA, and I-A hyaluronic acid is strongly recommended against for hip OA. Conditional recommendations against colchicine, non-tramadol opioids, fish oil, and vitamin D were made for all three joints.

The guideline is strongly in favor of the use of oral NSAIDs in all three joints, and conditionally recommended acetaminophen, tramadol, and duloxetine for all three joints.

Despite the newest guideline, the researchers stated in their conclusion, “A large research agenda remains to be addressed, with a need for more options with greater efficacy for the millions of people worldwide with osteoarthritis.”