“The new guideline emphasizes a comprehensive approach to the management of osteoarthritis rather than a stepwise algorithm,” said Dr. Sharon Kolasinski, a practicing rheumatologist who served as lead author for the guideline update. “The clinician and the patient are invited to choose from a varied list of interventions (educational, behavioral, psychosocial,
mind-body, physical and pharmacological approaches) that might be used and reused over time to address the pain and functional compromise caused by osteoarthritis.”
The Arthritis Foundation partnered with ACR by recruiting several patients with osteoarthritis who provided input from the patient perspective that helped to inform the guideline.
Kolasinski will discuss the draft recommendations at a press conference on Tuesday, Nov. 12, at 1:30 pm ET in Room B202 of the Georgia World Congress Center, as well as two sessions during the meeting program:
- Non-Drug Interventions for Hip, Knee & Hand OA: 2019 Guideline Update (Wednesday, Nov. 13, 7:30 – 8:30 am)
- 2019 ACR/AF Guideline for the Management of OA of the Hand, Knee and Hip (Wednesday, Nov. 13, 9 – 10 am)
Exercise remains as an important intervention in the updated recommendations, with a strong body of literature supporting its use for almost all patients with OA. However, clinicians can expect to see several differences between the new recommendations and the 2012 guideline, including:
- Strong recommendations (previously conditional) for self-efficacy/self-management programs, use of tai chi for knee and hip OA, topical NSAIDs for knee and hand OA, oral NSAIDs and intra-articular steroids for knee and hip OA.
- A new conditional recommendation for balance exercises for knee and hip OA and duloxetine for knee OA.
- A conditional recommendation for using topical capsaicin in patients with knee OA (previously conditional against).
- New conditional recommendations for using yoga, cognitive behavioral therapy, radiofrequency ablation and kinesiotaping for first carpometacarpal and knee OA.
- A conditional recommendation against using manual therapy with exercise for knee and hip OA (previously was conditionally for usage).
- A strong recommendation against transcutaneous electric nerve stimulation for knee and hip OA (previously was a conditional recommendation).
- A new conditional recommendation against using intra-articular hyaluronic acid injections in first carpometacarpal and knee OA.
- A strong recommendation against using glucosamine, and for using chondroitin, in patients with knee and hip OA (previously were conditional recommendations).
A notable addition to the updated guideline is a new strong recommendation against using hyaluronic acid injection in patients with hip OA. No recommendation regarding the use of hyaluronic acid injections in the hip was specified in 2012.
“In the current revision, hyaluronic acid injections for first carpometacarpal and knee OA were conditionally recommended against and hyaluronic acid injection for hip OA was strongly recommended against,” said Kolasinski. “These recommendations were made based on our meta-analysis which indicated that, when high quality studies are evaluated, hyaluronic acid injections are not superior to saline injections.
It was also recognized that contextual effects could play a role in reported benefits in studies with a greater risk of bias. While clinicians may consider hyaluronic acid injections for patients who have failed multiple alternative interventions and have limited alternative options, the decision to choose hyaluronic acid injections requires shared decision making between the patient and the clinician that weighs the risks and benefits relevant to the individual patient.”
Recommendations were also made against the use of bisphosphonates, hydroxychloroquine, methotrexate, PRP injections (in hip and knee OA), stem cell injections (in hip and knee OA), tumor necrosis factor inhibitors and interleukin-1 receptor antagonists. The guideline team found that several agents had been tested since the last update and had failed to show adequate benefit to justify their use, while others will require additional investigations to clarify their place in the OA armamentarium. The recommendations against usage of these therapies reflects the fact that pharmacologic options remain limited for the management of OA. A broad suggested research agenda is outlined in the guideline to address this gap.
The manuscript containing the full list of recommendations and supporting evidence is currently under peer review and is scheduled to be published by early 2020.
About the ACR/ARHP Annual Meeting
The ACR/ARP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR19).
About the American College of Rheumatology
The American College of Rheumatology (ACR) is an international medical society representing over 8,500 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
About the Arthritis Foundation The Arthritis Foundation is the Champion of Yes. Leading the fight for the arthritis community, the Foundation helps conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. The Arthritis Foundation’s goal is to chart a winning course, guiding families in developing personalized plans for living a full life – and making each day another stride toward a cure. The Foundation also publishes Arthritis Today, the award-winning magazine that reaches 4 million readers. For more information, visit www.arthritis.org.
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