By Laura Fonda Hochnadel
The American College of Rheumatology (ACR) and the Arthritis Foundation (AF) partnered to update and publish the 2019 ACR/AF Guideline for the Management of Osteoarthritis [OA] of the Hand, Hip and Knee. Last published in 2012, the updated guideline includes contributions to the literature since the last publication, and for the first time direct patient participation was incorporated.
OA affects about 250 million people worldwide, including an estimated 27 million Americans. It is the most common form of arthritis—most often affecting the knees, hips, and hands—and a leading cause of disability in older adults. Women are more likely to be affected than men. Risk factors include obesity, occupations that involve excessive joint loading, and repetitive trauma or joint injuries. Symptoms include joint pain, stiffness, limited range of motion, and swelling, and they can be activity-dependent, intermittent, or persistent.
The following summary focuses on interventions for OA of the knee and hip, with an emphasis on non-pharmacologic treatment. Treatment options that have received strong recommendations are noted in the table above.
The 2019 guidelines include new conditional recommendations for OA interventions of both the knee and hip. These new conditional recommendations are balance exercises, yoga, cognitive behavioral therapy, and radiofrequency ablation, along with kinesiotaping for knee OA. Conditional recommendations for OA treatment of both the knee and hip that were included in the 2012 guideline include acupuncture and thermal interventions, and patellofemoral braces for knee OA.
The update listed conditional recommendations against the use of lateral and medial wedged insoles, modified shoes, and massage therapy for both knee and hip OA. In the 2012 guideline, massage therapy was conditionally recommended. Manual therapy with exercise is conditionally recommended against over exercise alone in patients with knee and/or hip OA, while transcutaneous electrical nerve stimulation is strongly recommended against in these two patient populations.
The guideline authors also note that patients are more apt to participate in and continue with exercise programs that meet their preferences; are accessible; and consider their values, comorbidities, and circumstances. Supervised exercise or those coupled with self-efficacy, self-management, and weight loss programs also lead to increased compliance and participation. According to the guideline authors, “optimal management requires a comprehensive, multimodal approach to treating patients…offered in the context of shared decision making with patients, to choose the safest and most effective treatment possible.”
To access the complete guideline, which includes pharmacologic and surgical treatments, visit the ACR website at rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Osteoarthritis.
Laura Fonda Hochnadel is Associate Editor for LER.
Source: Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162.