Sharon L Kolasinski1, Tuhina Neogi2, Marc C Hochberg3, Carol Oatis4, Gordon Guyatt5, Joel Block6, Leigh Callahan7, Cindy Copenhaver8, Carole Dodge9, David Felson2, Kathleen Gellar10, William F Harvey11, Gillian Hawker12, Edward Herzig13, C Kent Kwoh14, Amanda E Nelson7, Jonathan Samuels15, Carla Scanzello1, Daniel White16, Barton Wise17, Roy D Altman18, Dana DiRenzo19, Joann Fontanarosa20, Gina Giradi20, Mariko Ishimori21, Devyani Misra2, Amit Aakash Shah22, Anna K Shmagel23, Louise M Thoma7, Marat Turgunbaev22, Amy S Turner22, James Reston20. 1. University of Pennsylvania School of Medicine, Philadelphia. 2. Boston University School of Medicine, Boston, Massachusetts. 3. University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore. 4. Arcadia University, Glenside, Pennsylvania. 5. McMaster University, Hamilton, Ontario, Canada. 6. Rush University Medical Center, Chicago, Illinois. 7. University of North Carolina School of Medicine, Chapel Hill. 8. South Holland Recreational Services, University of Chicago, and Ingalls Memorial Hospital, Thornton, Illinois. 9. University of Michigan Medical Center, Ann Arbor. 10. Watchung, New Jersey. 11. Tufts Medical Center, Boston, Massachusetts. 12. University of Toronto, Toronto, Ontario, Canada. 13. Fairfield, Ohio. 14. University of Arizona College of Medicine, Tucson. 15. New York University Langone Medical Center, New York, New York. 16. University of Delaware, Newark. 17. University of California, Davis. 18. Ronald Reagan UCLA Medical Center, Los Angeles, California. 19. Johns Hopkins University School of Medicine, Baltimore, Maryland. 20. ECRI Institute, Plymouth Meeting, Pennsylvania. 21. Cedars Sinai Medical Center, Los Angeles, California. 22. American College of Rheumatology, Atlanta, Georgia. 23. University of Minnesota, Minneapolis.
Abstract
OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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