2019 ACR/Arthritis Foundation Guidelines for Hand, Hip, and Knee Osteoarthritis Management

The latest recommendations are outlined below.

Part 1: Physical, Psychosocial, and Mind-Body Approaches

Strong Recommendations:

• Exercise is strongly recommended for patients with knee, hip, and/or hand OA. Considerably more evidence exists supporting the use of exercise for knee and hip OA than hand OA; however, current evidence is insufficient to recommend a specific exercise prescription, and recommendations suggesting 1 type of exercise over another are largely based on expert opinion. Exercise recommendations should focus on patient preferences and access, both of which could act as barriers to participation. Although walking was the most common form of exercise evaluated in a majority of studies examining the role of aerobic exercise in OA management, a specific hierarchy of the various forms of exercise could not be identified from current literature. However, to provide the best benefit, physicians are recommended to provide advice to patients that is “as specific as possible.”

• Weight loss is strongly recommended for patients with knee and/or hip OA who are overweight or obese. Current evidence suggests that a loss of ≥5% of body weight may be associated with changes in clinical and mechanistic OA outcomes. These clinically important benefits will continue to increase with weight loss of 5% to 10%, 10% to 20%, and >20% of body weight.

• Self-efficacy and self-management programs are strongly recommended for patients with knee, hip, and/or hand OA. Despite generally small effect sizes, multiple studies have demonstrated consistent benefits resulting from participation in self-efficacy and self-management programs, with minimal risk. Recommended programs typically have used a multidisciplinary, group-based format that combine skill-building education related to OA and education about medication side effects, joint protection measures, and fitness and exercise goals.

• Tai chi is strongly recommended for patients with knee and/or hip OA. Tai chi, which combines meditation with “slow, gentle, graceful movements,” may provide holistic benefits in terms of strength, balance, and fall prevention, in addition to depression and self-efficacy.

• Cane use is strongly recommended for patients with knee and/or hip OA. Patients in whom in 1 or more joints causes a sufficiently large effect on ambulation, joint stability, or pain are recommended to use an assistive device.

• Tibiofemoral knee braces are strongly recommended for patients with knee OA. Patients in whom disease in either 1 or both knees causes a sufficiently large effect on ambulation, joint stability, and pain warrant the need for an assistive device. Patients must be able to tolerate the inconvenience and burden associated with bracing.

• Hand orthoses are strongly recommended for patients with first carpometacarpal (CMC) joint OA.

• Transcutaneous electrical stimulation (TENS) is strongly recommended against in patients with knee and/or hip OA. Studies examining TENS are of low quality with small sample sizes and variable controls.

This article originally appeared on Rheumatology Advisor