Chondroitin sulfate is strongly recommended against in patients with knee and/or hip OA as are combination products that include glucosamine and chondroitin sulfate, but is conditionally recommended for patients with hand OA. Reference: American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Arthritis Rheum 43(9):1905-15, 2000. Osteoarthritis year in review 2020: Rehabilitation and outcomes. Exercise is associated with better outcomes when supervised. Is it safe? We conditionally recommend against the use of topical capsaicin in hand OA because of a lack of direct evidence to support use, as well as a potentially increased risk of contamination of the eye with use of topical capsaicin to treat hand OA. The appropriate use of other oral agents, particularly acetaminophen and opioids, will continue to evolve 39-41. Paraffin, an additional method of heat therapy for the hands, is conditionally recommended for patients with hand OA. Acupuncture is conditionally recommended for patients with knee, hip, and/or hand OA. RFA = radiofrequency ablation; NSAIDs = nonsteroidal antiinflammatory drugs; IA = intraarticular. Implimenting guidelines. 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. Clinicians treating patients in these circumstances should choose interventions with a low risk of harm, but both clinicians and patients may be dissatisfied with the options and unsure of how to choose among them. Methods: A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were … Low Dose Radiation Therapy, Particularly with 0.5 Gy, Improves Pain in Degenerative Joint Disease of the Fingers: Results of a Retrospective Analysis. Clinical considerations aimed at risk mitigation for the safe use of NSAIDs, such as appropriate patient selection, regular monitoring for the development of potential adverse gastrointestinal, cardiovascular, and renal side effects and potential drug interactions, were not specifically included in the GRADE process for the formulation of recommendations. Duloxetine is conditionally recommended for patients with knee, hip, and/or hand OA. An Update on Targets for Treating Osteoarthritis Pain: NGF and TRPV1. Nonetheless, the process of updating treatment guidelines permits scrutiny of the state of the literature and identification of critical gaps in our knowledge about best practices. Category Current guidelines. Individual preferences, access, and affordability are likely to play a role in what works best for an individual patient. The weight of the evidence indicates a lack of efficacy and large placebo effects. A number of trials in OA demonstrated small effect sizes with vitamin D treatment, while others have shown no benefit and pooling data across studies yielded null results. All rights reserved. Documents related to the 2019 Osteoarthritis Guideline: American College of Rheumatology Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee - 2012. Oral NSAIDs remain the mainstay of the pharmacologic management of OA, and their use is strongly recommended. Number of times cited according to CrossRef: Combination of magnesium ions and vitamin C alleviates synovitis and osteophyte formation in osteoarthritis of mice. Emerging pharmaceutical therapies for osteoarthritis. OA is characterized by pathology involving the whole joint, including cartilage degradation, bone remodeling, osteophyte formation, and synovial inflammation, leading to pain, stiffness, swelling, and loss of normal joint function. Knee osteoarthritis: key treatments and implications for physical therapy. This treatment has not been evaluated in hand OA and, therefore, no recommendation is made with regard to OA of the hand. Strengthening exercises have included the use of isokinetic weight machines, resistance exercise training with and without props such as elastic bands, and isometric exercise. These recommendations represent a change from the prior conditional recommendation against the use of glucosamine. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee Arthritis Care Res (Hoboken) . Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 1 The guideline—which is an update of the 2012 ACR recommendations on the use of nonpharmacologic and pharmacologic therapies in hand, hip, and knee OA—includes recommendations on how to comprehensively manage OA. The American College of Rheumatology (ACR) and the Arthritis Foundation have released a guideline for the management of hand, hip, and knee osteoarthritis (OA). Unless otherwise specified, recommendations regarding physical, psychosocial, and mind‐body approaches assume that the patient will be adding the intervention to usual care. Risk of venous thromboembolism in knee, hip and hand osteoarthritis: a general population-based cohort study. Nonetheless, there are circumstances in which tramadol or other opioids may be appropriate in the treatment of OA, including when patients may have contraindications to NSAIDs, find other therapies ineffective, or have no available surgical options. Colchicine is conditionally recommended against in patients with knee, hip, and/or hand OA. This treatment has not been evaluated in hand OA and, therefore, no recommendation is made with regard to OA of the hand. κ Osteoarthritis Year in Review 2020: Epidemiology & Therapy. We focused on management options that are available in the US and, for pharmacologic therapies, we additionally focused on agents that are available in pharmaceutical‐grade formulations, thus eliminating most nutraceuticals. Although manual therapy can be of benefit for certain conditions, such as chronic low back pain, limited data in OA show little additional benefit over exercise alone for managing OA symptoms. There is a well‐established body of literature 19, 20 supporting the use of CBT in chronic pain conditions, and CBT may have relevance for the management of OA. However, in considering all the ways in which OA may be affecting an individual patient, shared decision‐making between the physician and patient may include consideration of any of these agents. Going from evidence to recommendations: the significance and presentation of recommendations, GRADE guidelines: 15. Massage therapy encompasses a number of techniques aimed at affecting muscle and other soft tissue (NCCIH: https;://nccih.nih.gov/healt;h/massa;ge/massa;geint;roduc;tion.htm#hed2). Acupuncture and Chronic Musculoskeletal Pain. Where recommendations are made regarding a particular approach, details and references regarding that approach can be found in the Evidence Report (Supplementary Appendix 2, http://onlin;elibr;ary.wiley.com/doi/10.1002/art.41142/;abstract). The feasibility and effectiveness of internet-based rehabilitation for patients with knee osteoarthritis. Few studies have employed monitoring devices or pre‐ and postintervention assessment of cardiovascular or musculoskeletal fitness, so targets using these devices or assessments are not available. Guidelines for the medical management of osteoarthritis. Supplementary Appendix 4 (http://onlin;elibr;ary.wiley.com/doi/10.1002/art.41142/;abstract) shows search terms used and databases reviewed, and Supplementary Appendix 5 (http://onlin;elibr;ary.wiley.com/doi/10.1002/art.41142/;abstract) highlights the study selection process. However, based on the available evidence regarding OA specifically, a conditional recommendation against the use of massage for reduction of OA symptoms is made, though the Voting Panel acknowledged that massage may have other benefits. Association Between Acupuncture and Knee Surgery for Osteoarthritis: A Korean, Nationwide, Matched, Retrospective Cohort Study. Methods A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. These guidelines, published in Arthritis Care & Research, provide recommendations for clinicians and for patients with OA and encourage the use of a shared decision-making model that accounts for patient preferences and … Variability in the results of RCTs and meta‐analyses is likely driven, in part, by differences in the type of controls and the intensity of the control interventions used. Furthermore, clinically important benefits continue to increase with weight loss of 5–10%, 10–20%, and >20% of body weight. ACR policy guided management of conflicts of interest and disclosures (https;://www.rheum;atolo;gy.org/Pract;ice-Quali;ty/Clini;cal-Suppo;rt/Clini;cal-Pract;ice-Guide;lines/;Osteo;arthr;itis). A hierarchy of outcome measures assessing pain and function in OA was developed based on the published literature 8, 9. Intraarticular glucocorticoid injection is conditionally, rather than strongly, recommended for hand OA given the lack of evidence specific to this anatomic location. A substantial body of literature (see Evidence Report, Supplementary Appendix 2 [http://onlin;elibr;ary.wiley.com/doi/10.1002/art.41142/;abstract]) supports a wide range of appropriate exercise options and suggests that the vast majority of OA patients can participate in, and benefit from with regard to pain and function, some form of exercise. There are no published RCTs evaluating iontophoresis for OA in any anatomic location. Arthritis Rheum. As none of these agents were approved for use by the FDA and the longer‐term data were not available at the time of the literature review and Voting Panel meeting, we are unable to make recommendations regarding the use of anti‐NGF therapy. However, imaging guidance for injection into hip joints is strongly recommended. This study failed to show efficacy of a higher dose of fish oil over a lower dose. There are insufficient data to judge the choice of short‐acting over long‐acting preparations or the use of low rather than high doses. Considering the utility of these agents in pain management generally, their use may be an appropriate target of future investigations specific to OA. 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. Evidence suggests that duloxetine has efficacy in the treatment of OA when used alone or in combination with NSAIDs; however, there are issues regarding tolerability and side effects. Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial. Manual therapy with exercise is conditionally recommended against over exercise alone in patients with knee and/or hip OA. Recommendations of the French Society of Rheumatology on pharmacological treatment of knee osteoarthritis. Topical capsaicin is conditionally recommended for patients with knee OA and conditionally recommended against in patients with hand OA. The delivery of instruction by physical and occupational therapists is helpful, and often essential, for the appropriate initiation and maintenance of exercise as a part of OA management. International Journal of Environmental Research and Public Health. Tumor necrosis factor inhibitors and interleukin‐1 receptor antagonists are strongly recommended against in patients with knee, hip, and/or hand OA. Differences between diffuse idiopathic skeletal hyperostosis and spondyloarthritis. In contrast to intraarticular therapies discussed above, there is concern regarding the heterogeneity and lack of standardization in available preparations of platelet‐rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected. Comment in Arthritis Rheum. Spezielle Schmerztherapie bei rheumatischen Erkrankungen. Prolotherapy is conditionally recommended against in patients with knee and/or hip OA. International Journal of Molecular Sciences. Objective. These recommendations should not be used to limit or deny access to therapies. Most patients with OA are likely to experience benefit from referral to physical therapy and/or occupational therapy at various times during the course of their disease. Indeed, interventions that have proven beneficial in the management of chronic pain may prove useful in OA 17 even when data specific to patients with OA are limited. For those with limited pharmacologic options due to intolerance of or contraindications to the use of NSAIDs, acetaminophen may be appropriate for short‐term and episodic use. Kinesiotaping is conditionally recommended for patients with knee and/or first CMC joint OA. In OA generally, intraarticular glucocorticoid injection is conditionally recommended over other forms of intraarticular injection, including hyaluronic acid preparations. Expert Review of Precision Medicine and Drug Development. Moderate Mechanical Stimulation Protects Rats against Osteoarthritis through the Regulation of TRAIL via the NF- However, for some patients at some time points, a single physical, psychosocial, mind‐body, or pharmacologic intervention may be adequate to control symptoms; for others, multiple interventions may be used in sequence or in combination. The Arthritis Foundation is proud to have partnered with the American College of Rheumatology (ACR) on the development and release of these guidelines for the management of osteoarthritis (OA) of the hand, knee and hip. This hierarchy is detailed in Supplementary Appendix 1 (http://onlin;elibr;ary.wiley.com/doi/10.1002/art.41142/;abstract). Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation. Initial observations addressing the use of anti–nerve growth factor (anti‐NGF) agents suggest that significant analgesic benefits may occur but that incompletely explained important safety issues may arise. Going from evidence to recommendation—determinants of a recommendation's direction and strength, Shared decision making: a model for clinical practice, for the Agency for Healthcare Research and Quality, Noninvasive nonpharmacological treatment for chronic pain: a systematic review. The GRADE approach used provided a comprehensive, explicit, and transparent methodology for developing recommendations for OA management. The American College of Rheumatology (ACR), in conjunction with the Arthritis Foundation, published an updated evidence-based guideline for the comprehensive management of osteoarthritis (OA) of the hand, hip, and knee. Few trials have addressed pulsed vibration therapy, and in the absence of adequate data, we conditionally recommend against its use. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. An evidence review of osteoarthritis, with focus on the obese – considering conservative management, multi-morbidity, surgery and the implications of restricted access to knee or hip replacement because of weight.. International Journal of Orthopaedic and Trauma Nursing. Journal of Orthopaedic Surgery and Research. The conditional recommendation against is consistent with the use of hyaluronic acid injections, in the context of shared decision‐making that recognizes the limited evidence of benefit of this treatment, when other alternatives have been exhausted or failed to provide satisfactory benefit. Studies addressing massage have suffered from high risk of bias, have included small numbers of patients, and have not demonstrated benefit for OA‐specific outcomes. New 2020 osteoarthritis guidelines, developed by the American College of Rheumatology and the Arthritis Foundation, were previewed during ACR 2019. COVID-19, osteoarthritis and women's health. This guideline applies to patients with OA with no specific contraindications to the recommended therapies. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision, as warranted by the evolution of medical knowledge, technology, and practice. Management of knee osteoarthritis in primary care. Voices of African American Older Adults on the Implications of Social and Healthcare-Related Policies for Osteoarthritis Pain Care. In the majority of studies that assessed the role of aerobic exercise in the management of OA, walking was the most common form of exercise evaluated, either on a treadmill or as supervised, community‐based, indoor fitness walking. During the GRADE analysis, clinical trials involving physical modalities and mind‐body approaches were often designated as yielding low‐quality evidence because blinding with regard to the active treatment was not always possible. 1991 May;34(5):505-14. doi: 10.1002/art.1780340502. Medication Guides . Vol. NICE accredits our clinical guideline process; this is valid until February 2022. Polymyalgia rheumatica. JMIR Rehabilitation and Assistive Technologies. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. Dr. Neogi has received consulting fees from Pfizer, Regeneron, EMD Merck Serono, and Novartis (less than $10,000 each). Important directions for research include gaining a more comprehensive understanding of the optimal types of exercises and the modifications that should be used based on disease location and severity, study of the intensity of exercise that would be optimal for a given individual (https;://health.gov/pagui;delin;es/second-editi;on/report.aspx), defining optimal footwear for patients with knee and hip OA and understanding the interaction between footwear and exercise, conducting rigorous RCTs for physical modality options in hand OA, assessing a broader array of outcomes, including fall prevention, assessing optimal use of oral, topical, and injectable agents alone and in combination, obtaining a better understanding of the role of integrative medicine, including massage, herbal products, medical marijuana, and additional mind‐body interventions, and exploring agents with novel mechanisms of action for prevention and treatment. Future research is essential to establish specific exercise guidelines that will direct the patient and provider toward more individualized exercise prescriptions. Watch past educational presentations and see live events in real time, Reference our medication guides for helpful information. Documents related to the 2012 Osteoarthritis Guideline: American College of Rheumatology Osteoarthritis Guidelines Non-pharmacological - Knee and Hip - 2009, © 2020 American College of Rheumatology. Other mind‐body practices could not be assessed due to insufficient evidence, as well as a lack of standard definitions of certain interventions (hypnosis, qi gong). Part II. Exercise is strongly recommended for patients with knee, hip, and/or hand OA. The Voting Panel made strong recommendations for patients to participate in a regular, ongoing exercise program. American College of Rheumatology. Tumor necrosis factor inhibitors and interleukin‐1 receptor antagonists have been studied in trials using both subcutaneous and intraarticular routes of administration. The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service. Measures aimed at improving mood, reducing stress, addressing insomnia, managing weight, and enhancing fitness may improve the patient's overall well‐being and OA treatment success. 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. Positive trials and meta‐analyses have also been published in a variety of other painful conditions and have indicated that acupuncture is effective for analgesia. 2020. We thank the patients who (along with author Kathleen Gellar) participated in the Patient Panel meeting: Cindy Copenhaver, LMT, Donna Dernier, Fletcher Johnson, Nancy J. Maier, Travis Salmon, Elise Sargent, and Linda Walls. Tibiofemoral knee braces are strongly recommended for patients with knee OA in whom disease in 1 or both knees is causing a sufficiently large impact on ambulation, joint stability, or pain to warrant use of an assistive device, and who are able to tolerate the associated inconvenience and burden associated with bracing. . 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