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Updated Recommendations for Hand, Hip, and Knee Osteoarthritis Therapy

Updated Recommendations for Hand, Hip, and Knee Osteoarthritis Therapy

The American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) have been updated, and new recommendations for hand OA have been developed, the organization announced. The recommendations, aimed at improving the treatment of patients with these disorders, call for the use of a combination of pharmacological and nonpharmacological therapies.

The ACR creates and updates criteria sets and clinical practice guidelines to help researchers and clinicians identify and manage challenging rheumatologic diseases. The OA recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines and are informed by available evidence. They balance the benefits and harms of pharmaceutical and nonpharmaceutical modalities and incorporate the experts' preferences and values.

The updated hip and knee OA recommendations were developed with a new methodology that includes systematic literature reviews and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, a system recognized for rating recommendations on quality, strength, and transparency. Highlighted are both strong recommendations (ample evidence of a large benefit with no or little risk) and conditional recommendations (only little or modest evidence or a small to moderate benefit that did not greatly outweigh the risks) and information about the safety and tolerability of new and existing therapies used to manage OA. The recommendations also address suggestions for patients who are not responding to or are intolerant of initial therapies and treatments and special circumstances (eg, the patient has other chronic medical conditions).

The hand OA recommendations, which consider the values and judgments of both patients and physicians, include the following:
Nonpharmacological. Conditionally recommend that health professionals evaluate patients for the ability to perform activities of daily living, instruct them in joint protection techniques and, for those with trapeziometacarpal joint OA, provide splints.
Pharmacological. Conditionally recommend that health professionals use topical agents (capsaicin or NSAIDs or both), oral NSAIDs, or tramadol.

The knee OA recommendations include the following:
Nonpharmacological. Strongly recommend that patients with knee OA participate in aerobic, resistance, and aquatic exercise and, if overweight, lose weight. Conditionally recommend that patients with knee OA participate in self-management programs and receive patient education and manual therapy in combination with supervised exercise.
Pharmacological. Conditionally recommend that patients with knee OA use acetaminophen, oral NSAIDs, topical NSAIDs, tramadol, or intra-articular corticosteroid injections and not use chondroitin sulfate, glucosamine, or topical capsaicin. Opioid analgesics should be reserved for patients who have an indication for total joint replacement but are unwilling or have contraindications to undergoing the procedure.

The hip OA recommendations include the following:
Nonpharmacological. Strongly recommend that patients with hip OA participate in aerobic, resistance, and aquatic exercise and, if overweight, lose weight. Conditionally recommend that patients with hip OA participate in self-management programs and receive patient education and manual therapy in combination with supervised exercise.
Pharmacological. Conditionally recommend that patients with hip OA use acetaminophen, oral NSAIDs, tramadol, or intra-articular corticosteroid injections and not use chondroitin sulfate or glucosamine. Opioid analgesics should be reserved for patients who have an indication for total joint replacement but are unwilling or have contraindications to undergoing the procedure.

OA is the most common form of arthritis that affects adults in the United States and is the principal cause of musculoskeletal pain, limitation in physical activity, and reduction in health-related quality of life, the ACR noted. The publication was created to provide guidance and not for diagnostic purposes.

The article "American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee" appears in the April issue of Arthritis Care & Research. For more information, visit the ACR Web site at http://www.rheumatology.org. Or, contact the organization at American College of Rheumatology, 2200 Lake Boulevard NE, Atlanta, GA 30319; telephone: (404) 633-3777; fax (404) 633-1870.

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