American College of Rheumatology/Arthritis Foundation Release Updated Treatment Guideline for Osteoarthritis

The American College of Rheumatology (ACR), in partnership with the Arthritis Foundation (AF), released the 2019 ACR/AF Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. The ACR periodically updates guidelines to reflect any advances in management added to the literature since the last publication, which in this case was 2012.

Osteoarthritis (OA) is a common rheumatic disease that affects the entire joint, involving the cartilage, joint lining, ligaments, and bone. It is characterized by breakdown of the cartilage (the tissue that cushions the ends of the bones between joints), bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the joint lining (called the synovium). According to the AF, approximately 27 million Americans suffer from the disease. Establishing effective management and treatment for OA is an ongoing goal in rheumatology.

For the first time, the new guideline incorporates direct patient participation in its development. OA patients, who were recruited through a partnership with the AF, were especially instrumental in emphasizing the role of shared decision making when choosing treatment options such as those with conditional recommendations.

“We are proud to have been involved in this work and to facilitate the important contributions of the patient and parent partners,” says Cindy McDaniel, AF’s senior vice president of consumer affairs. “Their lived experiences truly helped to guide this project.”

Between the extensive literature review and patient insight, the updated guideline includes several differences since the 2012 recommendations. Of note, exercise remains an important intervention in the updated recommendations, with a strong body of literature supporting its use for almost all patients with OA. Other recommendations included in the update include the following:

• strong recommendations (previously conditional) for self-efficacy/self-management programs, use of tai chi for knee and hip OA, topical NSAIDs for knee and hand OA, oral NSAIDs and intra-articular steroids for knee and hip OA;

• a new conditional recommendation for balance exercises for knee and hip OA and duloxetine for knee OA;

• a conditional recommendation for using topical capsaicin in patients with knee OA (previously conditional against);

• new conditional recommendations for using yoga, cognitive behavioral therapy, radiofrequency ablation and kinesiotaping for first carpometacarpal and knee OA;

• a conditional recommendation against using manual therapy with exercise for knee and hip OA (previously was conditionally for usage);

• a strong recommendation against transcutaneous electric nerve stimulation for knee and hip OA (previously was a conditional recommendation);

• a new conditional recommendation against using intra-articular hyaluronic acid injections in first carpometacarpal and knee OA; and

• a new strong recommendation against using hyaluronic acid injections in patients with hip OA.

The paper containing the full list of recommendations and supporting evidence is available at www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Osteoarthritis.

Source: American College of Rheumatology