Any queries (other than missing content) should be directed to the corresponding author for the article. 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. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide 1-5, and is a leading cause of disability among older adults. 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. 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. In contrast, the evidence of lack of benefit is of higher quality with respect to hyaluronic acid injection in the hip. The Voting Panel made strong recommendations when it inferred compelling evidence of efficacy and that benefits clearly outweighed harms and burdens. The Patient Panel noted that the broader impact of OA on these comorbidities is of particular importance when choosing among treatment options and best addressed by a multimodal treatment plan, rather than one that is limited to the prescription of a single medication. Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study. In addition, potential adverse effects, as well as drug interactions, may occur with use of colchicine. A retrospective cohort study in 565 patients.. Nano wet milled celecoxib extended release microparticles for local management of chronic inflammation. Sustained-release diclofenac conjugated to hyaluronate (diclofenac etalhyaluronate) for knee osteoarthritis: a randomized phase 2 study. Learn about our remote access options, University of Pennsylvania School of Medicine, Philadelphia, Boston University School of Medicine, Boston, Massachusetts, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, Arcadia University, Glenside, Pennsylvania, McMaster University, Hamilton, Ontario, Canada, Rush University Medical Center, Chicago, Illinois, University of North Carolina School of Medicine, Chapel Hill, South Holland Recreational Services, University of Chicago, and Ingalls Memorial Hospital, Thornton, Illinois, University of Michigan Medical Center, Ann Arbor, Tufts Medical Center, Boston, Massachusetts, University of Toronto, Toronto, Ontario, Canada, University of Arizona College of Medicine, Tucson, New York University Langone Medical Center, New York, New York, Ronald Reagan UCLA Medical Center, Los Angeles, California, Johns Hopkins University School of Medicine, Baltimore, Maryland, ECRI Institute, Plymouth Meeting, Pennsylvania, Cedars Sinai Medical Center, Los Angeles, California, American College of Rheumatology, Atlanta, Georgia. Medication Guides . Sulfurous-arsenical-ferruginous balneotherapy for osteoarthritis of the hand: results from a retrospective observational study. 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. A - Z . Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden. Therapies that were approved after the original systematic literature review are not included in these recommendations. Evidence-Based Complementary and Alternative Medicine. 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. Common practices in intraarticular corticosteroid injection for the treatment of knee osteoarthritis: A survey of the AAHKS membership. The Voting Panel made conditional recommendations for balance exercises, yoga, CBT, kinesiotaping, orthoses for hand joints other than the first CMC, patellofemoral bracing, acupuncture, thermal modalities, radiofrequency ablation, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. The guideline evidence base results from our own systematic review of randomized controlled trials (RCTs), rather than focusing on systematic reviews and meta‐analyses published by others, as was done for the 2012 ACR recommendations for the use of nonpharmacologic and pharmacologic therapies in hand, hip, and knee OA 7. Moderate Mechanical Stimulation Protects Rats against Osteoarthritis through the Regulation of TRAIL via the NF- The weight of the evidence indicates a lack of efficacy and large placebo effects. Part I. Osteoarthritis of the hip. In hip OA, the depth of the joint beneath the skin surface suggests that topical capsaicin is unlikely to have a meaningful effect, and thus, the Voting Panel did not examine use of topical capsaicin in hip OA. We reviewed www.clini;caltr;ials.gov to identify phase 2 and 3 trials that may be far enough along to be US Food and Drug Administration (FDA)–approved and available by the time this guideline was published. There is concern regarding the heterogeneity and lack of standardization in available preparations of stem cell injections, as well as techniques used. Physical Therapy before the Needle for Osteoarthritis of the Knee. Pulsed vibration therapy is conditionally recommended against in patients with knee OA. Osteoarthritis of the knee. 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. Recommended therapies for the management of osteoarthritis (OA). Dr. Altman has received consulting fees, speaking fees, and/or honoraria from Flexion, GlaxoSmithKline, Novartis, Olatec, Pfizer, Sorrento Therapeutics, and Teva Pharmaceutical Industries (less than $10,000 each). No recommendations were made for the other centrally acting agents due to lack of direct studies of relevance in OA. ACR Guidelines. 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. Documents related to the 2012 Osteoarthritis Guideline: American College of Rheumatology Osteoarthritis Guidelines Non-pharmacological - Knee and Hip - 2009, © 2020 American College of Rheumatology. The potential toxicity of glucosamine is low, though some patients exposed to glucosamine may show elevations in serum glucose levels 36. Aquatic exercise often encompasses aspects of aerobic fitness exercises and exercises for enhancing joint range of motion, in a low‐impact environment. We thank the ACR staff, including Regina Parker for assistance in organizing the face‐to‐face meeting and coordinating the administrative aspects of the project and Robin Lane for assistance in manuscript preparation. 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. However, clinical trials of exercise for OA include patients with pain and functional limitations due to OA, and improvements in OA‐specific outcomes have been demonstrated; thus, results are likely to be generalizable to most patients with pain due to OA. 1995 Nov;38(11):1541-6. doi: 10.1002/art.1780381104. ** = Knee brace recommendations: tibiofemoral (TF) brace for TF OA (strongly recommended), patellofemoral (PF) brace for PF OA (conditionally recommended). The recommendations provide an array of options for a comprehensive approach for optimal management of OA encompassing the use of educational, physical, behavioral, psychosocial, mind‐body, and pharmacologic interventions. Use of an internal review allowed the College’s own literature review team to … Intra-articular injections of platelet-rich plasma in symptomatic knee osteoarthritis: a consensus statement from French-speaking experts. We thank Nancy Baker, ScD, MPH, OTR/l, Yvonne Golightly, PT, MS, PhD, Thomas Schnitzer, MD, PhD, and ChenChen Wang, MD, MSc for serving (along with authors Joel Block, MD, Leigh Callahan, PhD, Carole Dodge, OT, CHT, David Felson, MD, MPH, William F. Harvey, MD, MSc, Edward Herzig, MD, Marc C. Hochberg, MD, MPH, Sharon L. Kolasinski, MD, C. Kent Kwoh, MD, Amanda E. Nelson, MD, Tuhina Neogi, MD, PhD, Carol Oatis, PT, PhD, Jonathan Samuels, MD, Daniel White, PT, ScD, and Barton Wise, MD, PhD) on the Expert Panel. The efficacy of weight loss for OA symptom management is enhanced by use of a concomitant exercise program. This guideline applies to patients with OA with no specific contraindications to the recommended therapies. The FDA temporarily halted clinical trials of anti‐NGF as a result, but trials have since resumed, with ongoing collection of longer‐term efficacy and safety data. Use of Herbal Medications for Treatment of Osteoarthritis and Rheumatoid Arthritis. 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. The American College of Rheumatology (ACR) and the Arthritis Foundation have released a guideline for the management of hand, hip, and knee osteoarthritis (OA). Radiology 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. RCTs of pharmacologic agents may be subject to a variety of limitations, including generalizability of their findings across patients. Strengthening exercises have included the use of isokinetic weight machines, resistance exercise training with and without props such as elastic bands, and isometric exercise. Tumor necrosis factor inhibitors and interleukin‐1 receptor antagonists are strongly recommended against in patients with knee, hip, and/or hand OA. 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. Knee osteoarthritis: key treatments and implications for physical therapy. Effectiveness of Traditional Chinese Exercise for Symptoms of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Low Dose Radiation Therapy, Particularly with 0.5 Gy, Improves Pain in Degenerative Joint Disease of the Fingers: Results of a Retrospective Analysis. Mesenchymal stem cell-derived exosomal microRNA-136-5p inhibits chondrocyte degeneration in traumatic osteoarthritis by targeting ELF3. Management of knee osteoarthritis in primary care. 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. Recommendations of the French Society of Rheumatology on pharmacological treatment of knee osteoarthritis. However, imaging guidance for injection into hip joints is strongly recommended. Objective. The heterogeneity of modalities and short duration of benefit for these interventions led to the conditional recommendation. American College of Rheumatology annual meeting A survey of 9,004 patients with rheumatic disease―both autoimmune-related and non-autoimmune―shows that patients may need continued medication counseling through the duration of the pandemic, finds a study due to be presented on Friday at the American College of Rheumatology. Statistically significant findings may represent benefits so small that they are not clinically important to patients. 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