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.Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the clinician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes, but cannot guarantee any specific outcome. 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. ACR recommendations are...

Rituximab is a promising new therapy for SLE. The variability of responses in patients with SLE may be related to HACA formation. The failure to respond to immunisations is surprising, in view of the apparently low risk of infections. Better biological markers are necessary to follow these patients during treatment.

This pilot study suggests that yoga may provide a feasible treatment option for previously yoga-naive, obese patients >50 years of age and offers potential reductions in pain and disability caused by knee OA. Future studies should compare yoga to other nonpharmacologic interventions for knee OA, such as patient education or quadriceps-strengthening exercises.

Transforming growth factor .1 (TGF-fl1), a homodimeric polypeptide (Mr 25,000), derives from inflammatory cells and acts as a chemoattractant for monocytes and fibroblasts. We report here that TGF-131 is also the most potent chemoattractant yet described for human peripheral blood neutrophils. Recombinant TGF-,t1 elicited dose-dependent directed migration of neutrophils under agarose that was inhibited in the presence of a neutalizing antibody to TGF-j91.Maximal chemotaxis was evoked by TGF-181 at femtomolar concentrations, whereas conventional chemoattractants act at nanomolar concentrations: on a molar basis, TGF-.81 was 150,000 times more potent than fMet-Leu-Phe. In contrast, TGF-,1 provoked neither exocytosis nor the production of superoxide by neutrophils. We further analyzed the mechanism by which TGF-p1 elicits chemotaxis (GTPase activity, Transforming growth factor /31 (TGF-,B1), a homodimeric polypeptide (Mr 25,000) originally purified from human platelets and placenta and from bovine kidney, may also be derived from inflammatory cells (macrophages, T lymphocytes, and neutrophils) (1, 2). TGF-f31 is a member of a multigene family and, although initially defined by its ability to stimulate anchorage-independent growth of nonneoplastic rat kidney fibroblasts (3), it demonstrates a wide variety of effects. TGF-pB1 elicits chemotaxis offibroblasts in concert with the synthesis of matrix proteins (collagen, fibronectin) (4,5) and is also a chemoattractant for peripheral blood monocytes at femtomolar concentrations (6).Neutrophils are the initial cell type found at areas of tissue damage. After exposure to phlogistons such as complement components or bacterial chemoattractants, neutrophils adhere to vascular surfaces, undergo chemotaxis, degranulate, and generate toxic oxygen metabolites (7). Since latent TGF-,31 may be activated by the low pH at inflammatory sites or by tissue proteases or exoproteases found on inflammatory cells, we investigated whether TGF-1B1 might in turn trigger neutrophil functions. We compared the effects of TGF-P1 with those of fMet-Leu-Phe (fMLP) on the recruitment (chemotaxis) and activation (degranulation and superoxide generation) of neutrophils. TGF-,j1 was an exquisitely potent chemoattractant, yet selective in eliciting only chemotaxis by neutrophils. Moreover, TGF-f31 bypassed classic signaling mechanisms (GTPase activity, intracellular Ca2+, actin polymerization) for chemotaxis and triggered protein synthesis. MATERIALS AND METHODSMaterials. Hepes-buffered saline (150 mM Na+/1.2 mM Mg2+/1.3 mM Ca2+/155 mM Cl-/10 mM Hepes, pH 7.43) or phosphate-buffered saline with Ca2+ and Mg2+ (0.68 mM Ca2+/0.5 mM Mg2+, pH 7.43) was used for all cell suspensions. fMLP was stored at 10 mg/ml in dimethyl sulfoxide and diluted into buffer before use. Ficoll 400, horse ferricytochrome c, and bovine serum albumin were obtained from Sigma. [_y-32P]GTP was purchased from Amersham. Recombinant human TGF-,81 and partially purified goat antibody to TGF-,81 were gifts of Michael Palladino (Ge...