Part 2: Pharmacologic Management

Strong Recommendations:

Topical NSAIDs are strongly recommended for patients with knee OA. Topical NSAIDs should be considered before the use of oral NSAIDs.

Oral NSAIDs are strongly recommended for patients with knee, hip, and/or hand OA. Oral NSAIDs are the mainstay of pharmacologic OA management, with many trials establishing their short-term efficacy. Oral NSAIDs are the initial oral medication choice for OA, regardless of anatomic location, and are recommended vs all other available oral medications.

Intra-articular glucocorticoid injections are strongly recommended for patients with knee and/or hip OA. Trials have demonstrated the short-term efficacy of intra-articular glucocorticoid injections.

Ultrasound guidance for intra-articular glucocorticoid injection is strongly recommended for injection into hip joints. When available, ultrasound guidance may help ensure accurate drug delivery into the joint.

Bisphosphonates are strongly recommended against in patients with knee, hip, and/or hand OA. A large amount of data show no improvement in pain or functional outcomes with bisphosphonate therapy.

Glucosamine is strongly recommended against in patients with knee, hip, and/or hand OA. Despite multiple studies, there are discrepancies in efficacy reported by trials that are industry-sponsored vs publicly funded, raising serious concerns about publication bias. This recommendation represents a change from the prior conditional recommendation against glucosamine use.

Chondroitin sulfate is strongly recommended against in patients with knee and/or hip OA as are combination products that include glucosamine and chondroitin sulfate.

Hydroxychloroquine is strongly recommended against in patients with knee, hip, and hand OA. No efficacy has been demonstrated in multiple well-designed randomized controlled trials of patients with erosive hand OA.

Methotrexate is strongly recommended against in patients with knee, hip, and/or hand OA. Well-designed randomized controlled trials have demonstrated no efficacy of methotrexate therapy.

Intra-articular hyaluronic acid injections are strongly recommended against in patients with hip OA. Evidence about the lack of benefit of hyaluronic acid injections in hip OA is of higher quality.

Platelet-rich plasma treatment is strongly recommended against in patients with knee and/or hip OA. There is concern surrounding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma.

Stem cell injections are strongly recommended against in patients with knee and/or hip OA. There is concern surrounding the heterogeneity and lack of standardization in available preparations of stem cell injections.

Tumor necrosis factor inhibitors and interleukin-1 receptor antagonists are strongly recommended against in patients with knee, hip, and/or hand OA. Efficacy for these treatments has not been demonstrated and because of uknown toxicity risks, they are not recommended.

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This article originally appeared on Rheumatology Advisor