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

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.

This article originally appeared on Rheumatology Advisor