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Treatment of Hand, Hip, and Knee Osteoarthritis - 2012 ACR Recommendations

Non-Pharmacologic and Pharmacologic Treatment Recommendations

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Updated April 25, 2012

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One of the biggest misconceptions about osteoarthritis is that nothing can be done to control symptoms and manage the disease. While there is no cure for osteoarthritis, there are treatment options. It is important for patients, as well as doctors, to be aware of current recommendations.

The American College of Rheumatology (ACR) issued treatment recommendations in 2000 for hip and knee osteoarthritis. A dozen years later, the ACR has released updated recommendations for the treatment of osteoarthritis. The recommendations are intended to provide guidance about treatment but they do not negate the need for an individual patient to be evaluated, and treatment should be based on their evaluation.

In the 2012 ACR update, treatment recommendations for hip and knee osteoarthritis were updated and recommendations were included for hand osteoarthritis as well. Non-pharmacologic (non-drug) and pharmacologic treatments were both included. The treatment recommendations were categorized as "strong" or "conditional." Here's an overview of the recommendations.

Non-Pharmacologic Treatment Modalities Conditionally Recommended for Hand Osteoarthritis

A doctor, physical therapist, or occupational therapist should evaluate each hand osteoarthritis patient for their ability to perform activities of daily living. Then, based on the evaluation, one or more of the following should be provided:

There were no strong recommendations made since the treatment options for hand osteoarthritis appeared to have only a small to moderate effect.

Pharmacologic Treatment Modalities Conditionally Recommended for Hand Osteoarthritis

Conditionally, it was recommended that hand osteoarthritis patients not be treated with opioid analgesic medications or intra-articular treatments. Also, for patients with erosive or inflammatory interphalangeal osteoarthritis, it is conditionally recommended that neither oral methotrexate nor sulfasalazine be used.

Non-Pharmacologic Treatment Modalities Strongly Recommended for Knee Osteoarthritis

Non-Pharmacologic Treatment Modalities Conditionally Recommended for Knee Osteoarthritis

  • Medial wedge insoles for valgus knee osteoarthritis
  • Subtalar strapped lateral insoles for varus knee osteoarthritis
  • Medial directed patellar taping
  • Manual therapy combined with supervised exercise
  • Walking aids
  • Thermal agents
  • Tai chi
  • Self-management programs
  • Psychosocial interventions

Acupuncture or treatment with TENS (transcutaneous electrical nerve stimulation) is conditionally recommended under special circumstances: when the patient has chronic moderate to severe pain and is a candidate for total knee replacement surgery but either is unwilling or unable to undergo the procedure.

Pharmacologic Treatment Modalities Conditionally Recommended for Knee Osteoarthritis

(Initial Management of Knee OA)

  • Acetaminophen
  • Oral and topical NSAIDS
  • Tramadol
  • Intra-articular corticosteroid injections

Treatment Recommendations for Patients Failing Non-Pharmacologic and Initial Pharmacologic Treatment Who Are Unwilling/Unable to Have Total Knee Replacement

  • Opioid analgesic medications (strongly recommended)
  • Duloxetine (conditionally recommended)

Non-Pharmacologic Treatment Modalities Strongly Recommended for Hip Osteoarthritis

  • Cardiovascular and/or resistance land-based exercise
  • Aquatic exercise
  • Lose weight, if patient is overweight

Non-Pharmacologic Treatment Modalities Conditionally Recommended for Hip Osteoarthritis

  • Self-management programs
  • Manual therapy in combination with supervised exercise
  • Psychosocial interventions
  • Thermal agents
  • Walking aids

Pharmacologic Treatment Conditionally Recommended for Initial Management of Hip Osteoarthritis

  • Acetaminophen
  • Oral NSAIDs
  • Tramadol
  • Intra-articular corticosteroid injections

Additionally, for both knee osteoarthritis and hip osteoarthritis, experts conditionally recommend patients not use chondroitin sulfate or glucosamine to manage the disease.

Sources:

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Hochberg MC et al. Arthritis Care & Research. Volume 64, Issue 4, pages 465–474, April 2012.
http://onlinelibrary.wiley.com/doi/10.1002/acr.21596/full

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