The American College of Rheumatology (ACR) and the Arthritis Foundation have released guidelines for the treatment of hand, hip, and knee osteoarthritis (OA). These guidelines, published in Arthritis Care & Research, provide recommendations for clinicians and for patients with OA and encourage the use of a shared decision-making model that accounts for patient preferences and values.
Investigators from both organizations followed the ACR guideline development process and the Grading of Recommendations, Assessment and Evaluation methodology to rate currently available evidence and develop the recommendations. They conducted an initial literature review through August 2018, providing a body of knowledge with which to work, followed by a systematic review of randomized controlled trials and certain selected observational studies.
Overall, the guideline authors suggested that a comprehensive plan for OA management is key. According to them, this plan may include “educational, behavioral, psychosocial, and physical interventions, as well as topical, oral, and intra-articular medications.” The applications of these interventions should be determined on an individual level, with some patients benefiting from 1 type of intervention at a time, and others benefiting from multiple interventions administered in sequence or in combination.
According to the researchers, treatment discussions should consider patients’ personal beliefs and preferences, as well as their current medical status. The guideline is applicable to patients with OA with “no specific contraindications to the recommended therapies.” Investigators cautioned that each patient should be assessed for medical conditions, including hypertension, cardiovascular disease, heart failure, gastrointestinal bleeding risk, and chronic kidney disease, along with other comorbidities that may result in increased risks for side effects with certain treatment modalities.
Investigators also noted that patients may experience a variety of additional symptoms resulting from the pain and functional limitations associated with OA and/or from their comorbidities. Assessing the broader effect of OA on these comorbidities is of particular importance when choosing treatment options and can be best managed through a multimodal treatment plan.
Finally, unless specified, the recommendations assume that patients will undertake the intervention in addition to usual care, which, for the purposes of this guideline, includes the use of maximally recommended or safely tolerated doses of over-the-counter oral nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen.
“Optimal management requires a comprehensive, multimodal approach to treating patients with hand, hip, and/or knee OA offered in the context of shared decision-making with patients, to choose the safest and most effective treatment possible,” the researchers noted. “A large research agenda remains to be addressed, with a need for more options with greater efficacy for the millions of people worldwide with [OA].”
This article originally appeared on Rheumatology Advisor