The American College of Rheumatology (ACR) and Arthritis Foundation have released a preview of the updated practice guideline on the management of osteoarthritis (OA) at the 2019 ACR/Association of Rheumatology Professionals (ARP) Annual Meeting. The guideline will highlight the management of hand, hip, and knee OA with recommendations on pharmacological and nonpharmacological treatments, self-management programs, and more.

“[Osteoarthritis] is a leading cause of disability, particularly in older adults, and the management recommendations are not just for the individuals with osteoarthritis, but for the public health [community] at large,” Sharon Kolasinski, MD, a professor of clinical medicine at the University of Pennsylvania, and lead author on the updated practice guideline for OA, said during a press conference at the meeting. “The high prevalence of OA means that most clinicians, regardless of what the focus of their practice is, will be called on to manage and treat osteoarthritis.”

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The full list of recommendations and supporting evidence are currently under review and are anticipated to be published by early 2020.

More scientific studies have provided additional evidence on the management of patients with OA since the publication of the previous version of the practice guideline in 2012. 

The updated guideline will focus on the management of OA of the hand, hip, and knee, because these are the most commonly affected sites of the body, as well as the sites for which there was the most published literature, according to Kolasinski.

The guideline highlighted by Kolasinski includes the following recommendations based on strong evidence, which were previously conditional in the 2012 guideline:

• Self-efficacy/self-management programs are suggested. More specifically, the use of tai chi for knee and hip OA; topical nonsteroidal anti-inflammatory drugs (NSAIDs) for knee and hand OA; and oral NSAIDs and intra-articular steroids for knee and hip OA.
• To treat patients with knee and hip OA, it is suggested against the use of transcutaneous electric nerve stimulation.
• To treat patients with knee and hip OA, it is suggested against the use of glucosamine and the use of chondroitin.

The guideline includes the following recommendations based on conditional evidence:

• The use of topical capsaicin for knee OA.
• For first carpometacarpal and knee OA, the use of yoga, cognitive behavioral therapy, radiofrequency ablation and the Kinesio taping method are suggested.
• For knee and hip OA, it is suggested against the use of manual therapy with exercise.
• To treat patients with first carpometacarpal and knee OA, it is suggested against using intra-articular hyaluronic acid injections.

Key points from the updated guideline, according to Kolasinski, include:

• The emphasis on using a comprehensive approach, rather than a stepwise algorithm, for OA management. “Clinicians and patients can really choose from a broad list of interventions,” Kolasinski said. “For a given intervention, there might be a period of time where it is useful and then the option might be changed. There is no real hierarchy of one option over the others, except on the basis of the strength of the recommendation.”
• Exercise and weight loss are critical and central to management. “This was also a strong recommendation in the 2012 guideline and remains a strong recommendation in this iteration of the guideline,” she said, adding that patients have many options to choose from. Weight loss is particularly important for patients with knee and hip OA who are overweight or obese.
• The expanded number of strong recommendations to include participation in self-efficacy and self-management programs, and more.
• The expanded number of conditional recommendations giving support to the use of balanced exercises, cognitive behavioral therapy, yoga for knee OA, and more.

The recommendations will 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. 

—Melinda Stevens

Reference:

American College of Rheumatology/Arthritis Foundation preview updated draft of osteoarthritis treatment guideline at the 2019 ACR/ARP Annual Meeting [press release]. Atlanta, GA: 2019 ACR/ARP Annual Meeting; November 9, 2019. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/1072. Accessed November 13, 2019.