American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee

Abstract

Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) Results. Both "strong" and "conditional" recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, selfmanagement programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. Conclusion. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA.

Impact and therapy of osteoarthritis: the Arthritis Care OA Nation 2012 survey

“…Self-management strategies were reported to be effective when employed; however despite good awareness of self-management amongst respondents they were considerably under-utilised, suggesting that current support for self-management may require optimisation. Self-management for long term conditions is a current priority of the NHS, and a core component of guidelines for the treatment of OA [41,42]. Further work to support implementation of self-management by people with OA is an important direction for clinical practice and future research.…”

Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries

“…Moderate levels of physical activity are recommended for persons with OA, provided the activity is not painful (12). The American College of Rheumatology (ACR) has identified exercise programs as first-line nonpharmacologic treatment and physical activity as one of the main targets in arthritis management programs for OA patients (13,14). This corresponds with a recent review of guidelines and recommendations for the management of OA.…”

What Do People With Knee or Hip Osteoarthritis Need to Know? An International Consensus List of Essential Statements for Osteoarthritis

“…Only English-language publications were retrieved. We extracted all recommendations from 12 evidence-based clinical practice guidelines (1,3,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Similar statements with duplicative content were reviewed by the investigators and merged into a single statement as appropriate.…”