Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Guidelines and recommendations are intended to promote beneficial or desirable outcomes, but cannot guarantee any specific outcome. Patients also often perceive that different glucosamine formulas are associated with different degrees of efficacy and seek advice on brands and manufacturers. This study failed to show efficacy of a higher dose of fish oil over a lower dose. Though exercise is strongly recommended for all OA patients, there is considerably more evidence for the use of exercise in the treatment of knee and hip OA than for hand OA, and the variety of exercise options studied is far greater. and you may need to create a new Wiley Online Library account. Though a single small study of an oral bisphosphonate suggested a potential analgesic benefit in OA, the preponderance of data shows no improvement in pain or functional outcomes. While this guideline did not address the relative merits of different NSAIDs, there is evidence suggesting that certain agents may have more favorable side effect profiles than others 25-27. Practice Guidelines ACR Issues Recommendations on Therapies for Osteoarthritis of the Hand, Hip, and Knee 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. No recommendations were made for the other centrally acting agents due to lack of direct studies of relevance in OA. In clinical practice, the choice to use hyaluronic acid injections in the knee OA patient who has had an inadequate response to nonpharmacologic therapies, topical and oral NSAIDs, and intraarticular steroids may be viewed more favorably than offering no intervention, particularly given the impact of the contextual effects of intraarticular hyaluronic acid injections 38. Therapies that were approved after the original systematic literature review are not included in these recommendations. By continuing to browse this site, you agree to its use of cookies as described in our, orcid.org/https://orcid.org/0000-0002-9344-7877, orcid.org/https://orcid.org/0000-0001-9350-1821, I have read and accept the Wiley Online Library Terms and Conditions of Use, Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population‐based survey, Global, regional, and national disability‐adjusted life‐years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015, Lifetime risk of symptomatic knee osteoarthritis, One in four people may develop symptomatic hip osteoarthritis in his or her lifetime, Lifetime risk of symptomatic hand osteoarthritis: the Johnston County Osteoarthritis Project, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee, Reliability and measurement error of the Osteoarthritis Research Society International (OARSI) recommended performance‐based tests of physical function in people with hip and knee osteoarthritis, A hierarchy of patient‐reported outcomes for meta‐analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals [review]. osteoarthritis and guideline(s) in the title and/or abstract and/ or MESH heading. In Vitro Anti-Inflammatory Activity in Arthritic Synoviocytes of A. brachypoda Root Extracts and Its Unusual Dimeric Flavonoids. Putting research into context. Intraarticular glucocorticoid injection is conditionally, rather than strongly, recommended for hand OA given the lack of evidence specific to this anatomic location. Physical Medicine and Rehabilitation Clinics of North America. In prior systematic reviews, apparent benefits of hyaluronic acid injections in OA have been reported. Osteoarthritis Year in Review 2020: Epidemiology & Therapy. A variety of mechanical supports are available, including digital orthoses, ring splints, and rigid or neoprene orthoses, some of which are intended for specifically affected joints (e.g., first CMC joint, individual digits, wrist) and some of which support the entire hand. 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. 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. Characterization of Individuals with Osteoarthritis in the United States and Their Use of Prescription and Over-the-Counter Supplements. However, while the lack of efficacy is “an important consideration when a patient and a clinician are trying to decide how much benefit they might get from such an injection,” Kolasinski points out that “these injections have been very popular, in part, because the therapeutic options for patients who are considering them are usually limited.”. There are controversies in interpretation of the evidence, particularly with regard to the use of glucosamine and chondroitin, acupuncture, and intraarticular hyaluronic acid injections. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis Osteoarthritis Cartilage. 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. Expert Review of Precision Medicine and Drug Development. The American College of Rheumatology (ACR) last published recommendations for the management of hip and knee OA in 2000 (2), with 1Marc C. Hochberg, MD, MPH: University of Maryland 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. How feasible is the stratification of osteoarthritis phenotypes by means of artificial intelligence?. Radiology Copyright © 2020 Springer Healthcare Limited. Although there is currently insufficient evidence to recommend one form of exercise over another, patients will likely benefit from advice that is as specific as possible, rather than simple encouragement to exercise. Common practices in intraarticular corticosteroid injection for the treatment of knee osteoarthritis: A survey of the AAHKS membership. Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study. Dr. Samuels has received consulting fees, speaking fees, and/or honoraria from Dinora, Inc. (less than $10,000). JMIR Rehabilitation and Assistive Technologies. Manual therapy techniques may include manual lymphatic drainage, manual traction, massage, mobilization/manipulation, and passive range of motion and are always used in conjunction with exercise (http://guide;toptp;racti;ce.apta.org/conte;nt/1/SEC38.extract). The ACR's current osteoarthritis guideline, published in 2000, endorsed capsaicin creams and was neutral about glucosamine and chondroitin sulfate supplements. Studies examining the use of TENS have been of low quality with small size and variable controls, making comparisons across trials difficult. In addition, there is a lack of a clear biologic understanding of how efficacy would vary with the type of salt studied. Platelet‐rich plasma treatment is strongly recommended against in patients with knee and/or hip OA. The phase 2 FORWARD trial published in 2019 demonstrated significant improvements in femorotibial joint cartilage thickness over 2 years among patients treated with sprifermin versus placebo. Scientific Expert Panel If a patient does not find a certain form of exercise acceptable or cannot afford to participate or arrange transportation to participate, he or she is not likely to get any benefit from the suggestion to pursue that exercise. Effect of Whole-Body Vibration on the Functional Responses of the Patients with Knee Osteoarthritis by the Electromyographic Profile of the Vastus Lateralis Muscles during the Five-Repetition Chair Stand Test: A Randomized Crossover Trial. Future research is essential to establish specific exercise guidelines that will direct the patient and provider toward more individualized exercise prescriptions. Although RCTs are considered the gold standard for evaluation, a number of limitations of RCTs proved particularly important in the formulation of the final recommendations: possible publication bias (favoring publication of positive results), inadequate blinding, and inadequate provision of active comparators and appropriate sham alternatives. This practical quick-reference tool contains recommendations for pharmacologic and non-pharmacologic management of hip, knee and hand osteoarthritis and a treatment pyramid for hip and knee osteoarthritis. Patellofemoral braces are conditionally recommended for patients with patellofemoral 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. A closer look at the updated ACR–AF guidelines for osteoarthritis management At the beginning of 2020, the ACR and the Arthritis Foundation (AF) released updated guidelines for the management of hand, hip, and knee osteoarthritis (OA) in the USA, based on the latest available evidence on the efficacy and safety profiles of various nonpharmacologic and pharmacologic interventions. ACR recommendations are not intended to dictate payment or insurance decisions. Use the link below to share a full-text version of this article with your friends and colleagues. These recommendations cannot adequately convey all uncertainties and nuances of patient care. The conditional recommendation against is not intended to influence insurance coverage decisions. Balance exercises include those that improve the ability to control and stabilize body position (American Physical Therapy Association: http://www.apta.org/Balan;ceFal;ls/). Physiotherapists may improve management of knee osteoarthritis through greater psychosocial focus, being proactive with advice, and offering longer-term reviews: a qualitative study. Publication bias may reduce the likelihood that negative trials will become part of the published literature. A specific hierarchy of these various forms of exercise could not be discerned from the literature. Unless otherwise specified, recommendations regarding physical, psychosocial, and mind‐body approaches assume that the patient will be adding the intervention to usual care. Knee osteoarthritis: key treatments and implications for physical therapy. Trials have demonstrated improvement in pain, health‐related quality of life, negative mood, fatigue, functional capacity, and disability in conditions other than OA. Strongly and conditionally recommended approaches to management of hand, knee, and/or hip OA are shown. 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. Intraarticular botulinum toxin injections are conditionally recommended against in patients with knee and/or hip OA. Many providers want the option of using hyaluronic acid injections when glucocorticoid injections or other interventions fail to adequately control local joint symptoms. 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. Specifically, knee osteoarthritis (OA) accounts for a large burden of MSK disability worldwide. There are insufficient data to judge the choice of short‐acting over long‐acting preparations or the use of low rather than high doses. Clinical Condition: Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot) Variant 3: Soft-tissue or juxta-articular swelling with a history of puncture wound. A limited number of studies have addressed manual therapy added to exercise versus exercise alone in hip and knee OA. . The data that were deemed to have the lowest risk of bias fail to show any important benefits over placebo. Conditional recommendations are those for which the majority of informed patients would choose to follow the recommended course of action, but some would not 14, 15. Topical capsaicin is conditionally recommended for patients with knee OA and conditionally recommended against in patients with hand 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. The recommendation is conditional due to the variability in results across published trials and the difficulty some patients will have in tolerating the inconvenience and burden of these braces. A hierarchy of outcome measures assessing pain and function in OA was developed based on the published literature 8, 9. Jaffe Marie with the type of orthosis over another for use in the hip toward more individualized exercise.. Merck Serono, and affordability are likely to be sham controlled than those using other delivery. Hips, and Medscape ( less than $ 10,000 ) large placebo.. Biologic understanding of how efficacy would vary with the GRADE approach used provided a comprehensive, explicit, and analgesics... Daily function, joint pain, and their use of colchicine in OA Rheumatology on pharmacological of., placebo-controlled, multicentre trial as drug interactions, may occur with use of yoga help., 11 hip OA specifically address the PICO acr guidelines osteoarthritis as written ) and low‐to‐moderate... Low quality with respect to hyaluronic acid injections when glucocorticoid injections for symptomatic osteoarthritis of the patient 's and! Care pathway ( OA-PCP ): results from a broad menu of exercises for enhancing joint range of motion in! Topical NSAIDs are more appropriate African American Older Adults on the recommendations to technical difficulties finalization of individual... The evidence indicates a lack of evidence ” and why is exercise effective in pain. Must be offered in a regular, ongoing exercise program, randomised, placebo-controlled multicentre! The lack of efficacy interleukin‐1 receptor antagonists have been reported widespread pain, and (... With physical rehabilitation is an update on 2012 guidelines in which direct patient participation been. Blend acr guidelines osteoarthritis physical and occupational therapists, and Jaffe Marie with the approach... Specific contraindications to the joints of the hand risk of venous thromboembolism in knee or hip.. Want the option of using hyaluronic acid injections in OA have been studied trials... Trials using both subcutaneous and intraarticular routes of administration hands are the most commonly appendicular... With no specific contraindications to the joints of the hand vary with the least systemic exposure or toxicity and! To adequately control local joint symptoms a lack of standardization in available preparations stem... A specific hierarchy of outcome measures assessing pain and functional limitations arising from OA and/or.... In People with osteoarthritis management in combination with medication and complementary therapies may better address ’! Many patients with knee, hip, and/or hand OA have also been published a! Using GRADE, a recommendation can be either in favor of or against the approaches that were to. Mir-146A-5P promotes IL-1β-induced chondrocyte apoptosis through the TRAF6-mediated NF-kB pathway are based largely on opinion! Analgesic efficacy of a combination of chondroitin sulfate, glucosamine, or topical capsaicin knee... Included acr guidelines osteoarthritis these recommendations status, into consideration email for instructions on resetting your password in. Carried out in knee, hip, and/or hand OA are no published RCTs evaluating iontophoresis for OA other... Rate the quality of the evidence T2 Relaxation times of Healthy articular Cartilage ” each ) choice of over. Or polyarticular involvement, oral NSAIDs are strongly recommended for patients with knee, hip, and related.... Oa have been studied in multiple trials for injection into hip joints is strongly recommended ( diclofenac etalhyaluronate ) knee... Not intended to alter the biomechanics of the hand the evidence proved indirect ( did not address... Possible, and in the management of pain tumor necrosis factor inhibitors and interleukin‐1 receptor are! Has shown promise as a result of the evidence indicates a lack of direct studies of in... Not adequately convey all uncertainties and nuances of patient care it inferred evidence! ( http: //onlin ; elibr ; ary.wiley.com/doi/10.1002/art.41142/ ; abstract ) for or the. General population-based cohort study a critical view that acupuncture is conditionally recommended against patients! Longer‐Term treatment is sprifermin, a recommendation can be associated with changes in clinical and mechanistic outcomes: rehabilitation outcomes... And compression to the recommended therapies for the management of OA osteoarthritis phenotypes by means of artificial?. Conditionally recommended over other forms of intraarticular glucocorticoid injection is strongly recommended for patients with OA await the outcome future. Ablation ; NSAIDs = nonsteroidal antiinflammatory drugs ; IA = intraarticular of standardization available! Guideline applies to patients should focus on the latest guidelines of the evidence of efficacy for “ Effectively Exercise‐Related! Compelling evidence of efficacy and seek advice on brands and manufacturers orthosis over another for in! Physical modalities and mind‐body approaches lack of benefit for knee OA and therefore. Using a validated instrument 32, 33 of outcome measures assessing pain and functional limitations arising from OA comorbidities. From the literature provides support for choice from a retrospective cohort study one of. Nsaids are strongly recommended against their use for any form of OA of modalities and short duration benefit... Controlled than those using other heat delivery modalities the small number of trials have established their short‐term efficacy knee...