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Conditional Recommendations:
• Topical NSAIDs are conditionally recommended for patients with hand OA. Topical NSAIDs should be considered before the use of oral NSAIDs. Practical considerations, such as frequent hand washing, have led to a conditional recommendation for topical NSAID use in hand OA.
• Topical capsaicin is conditionally recommended for patients with knee OA and conditionally recommended against in patients with hand OA. Topical capsaicin is conditionally recommended against in hand OA due to a potentially increased risk for contamination of the eye and lack of direct evidence to support use.
• Intra-articular glucocorticoid injections are conditionally recommended for patients with hand OA. This practice is conditionally recommended because of lack of evidence specific to this anatomic location.
• Intra-articular glucocorticoid injections vs other injections are conditionally recommended for patients with knee, hip, and/or hand OA. Intra-articular glucocorticoid injections are conditionally recommended vs other forms of intra-articular injection, including hyaluronic acid.
• Acetaminophen is conditionally recommended for patients with knee, hip, and/or hand OA. Effect sizes in clinical trials for acetaminophen are very small, and longer-term treatment has been found to be as effective as placebo. Acetaminophen may be appropriate for patients in whom NSAIDs are contraindicated.
• Duloxetine is conditionally recommended for patients with knee, hip, and/or hand OA. Duloxetine may have treatment efficacy when used either alone or in combination with NSAIDs, although physicians should be aware of issues regarding tolerability and side effects.
• Tramadol is conditionally recommended for patients with knee, hip, and/or OA. In certain circumstances, tramadol or other opioids may be appropriate in the treatment of OA, including patients in whom NSAIDs are contraindicated.
• Non-tramadol opioids are conditionally recommended against in patients with knee, hand, and/or hip OA with the recognition that they may be used under certain circumstances, particularly when alternatives have been exhausted. Very modest benefits for long-term opioid benefit have been noted, in addition to a high risk for toxicity and dependence. The lowest possible dose should be used for the shortest length of time, if necessary.
• Colchicine is conditionally recommended against in patients with knee, hip, and/or hand OA. Two very small studies that suggested an analgesic benefit of colchicine in OA contained low-quality data. Potential adverse effects and drug interactions may occur with colchicine use.
• Fish oil is conditionally recommended against in patients with knee, hip, and/or hand OA. Despite its popularity as a dietary supplement, only 1 published trial has addressed the role of fish oil in OA; researchers of this study failed to demonstrate efficacy of a higher dose vs lower dose of fish oil.
• Vitamin D is conditionally recommended against in patients with knee, hip, and/or hand OA. Limited and questionable health benefits have been associated with vitamin D supplementation.
• Chondroitin sulfate is conditionally recommended for patients with hand OA. A single trial has suggested analgesic efficacy of chondroitin sulfate without evidence of harm in hand OA.
• Intra-articular hyaluronic acid injections are conditionally recommended against in patients with knee and/or first CMC joint OA. Although apparent benefits of hyaluronic acid injections have been reported, these reviews did not consider the risk for bias across individual primary studies. This conditional recommendation is against consistent use of hyaluronic acid injections.
• Intra-articular botulinum toxin injections are conditionally recommended against in patients with knee and/or hip OA. A small number of trials in knee or hip OA have suggested a lack of efficacy of intra-articular botulinum toxin treatment, and no trials have evaluated this treatment in hand OA.
• Prolotherapy is conditionally recommended against in patients with knee and/or hip OA. Only a limited number of trials with a small number of participants have demonstrated small effect sizes in knee or hip OA.
Reference
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee [published online January 6, 2020]. Arthritis Care Res. doi:10.1002/acr.24131
This article originally appeared on Rheumatology Advisor
