Updated recommendations for the treatment of osteoarthritis (OA) were released by the American College of Rheumatology (ACR), in collaboration with the Arthritis Foundation (AF). In addition to a panel of experts, for the first time, the guideline was developed with the help of patients, emphasizing the importance of shared decision-making. 

Exercise remains a strong recommendation for all OA patients and is supported by a substantial body of literature. Moreover, the guideline includes updated strong recommendations for the following interventions: 

  • Self-efficacy and self-management programs for patients with knee, hip and hand OA 
  • Tai chi for knee and hip OA
  • Topical NSAIDs for knee and hand OA
  • Oral NSAIDs and intraarticular glucocorticoid injections for knee and hip OA

The panel also strongly recommended against the use of transcutaneous electric nerve stimulation for knee and hip OA and hyaluronic acid injections in patients with hip OA.

New conditional recommendations included balance exercises for knee and hip OA and yoga, cognitive behavioral therapy, radiofrequency ablation and kinesiotaping for first carpometacarpal and knee OA, while the panel conditionally recommended against the use of manual therapy with exercise for knee and hip OA. 

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As for pharmacological therapies, conditional recommendations for the use of topical capsaicin and oral duloxetine for knee OA were added, while the panel conditionally recommended against the use of intraarticular hyaluronic acid injections in first carpometacarpal and knee OA.

Additional updates regarding pharmacological management advised against the use of bisphosphonates, hydroxychloroquine, methotrexate, platelet-rich plasma (PRP) injections (in hip and knee OA), stem cell injections (in hip and knee OA), tumor necrosis factor inhibitors and interleukin-1 receptor antagonists.

“The new guideline recognizes not only the variety of clinical presentations of OA, but also the broad array of treatment options available,” said Sharon Kolasinski, MD, a practicing rheumatologist who served as lead author for the guideline update. “Clinicians and patients can choose from educational, behavioral, psychosocial, mind-body, physical and pharmacological approaches.”

The full guideline can be accessed here.