Osteoarthritis

Publication Date: January 6, 2020

Treatment

Treatment

Hand:

Table 1. Nonpharmacologic Recommendations for the Management of Hand Osteoarthritis (OA)a

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The ACR conditionally recommends that health professionals should do the following:
  • Evaluate the ability to perform activities of daily living (ADLs)
  • Instruct in joint protection techniques
  • Provide assistive devices, as needed, to help patients perform ADLs
  • Instruct in use of thermal modalities
  • Provide splints for patients with trapeziometacarpal joint OA

No strong recommendations were made for the nonpharmacologic management of hand aOA. The evidence supporting these interventions demonstrated only a small to moderate effect.

Table 2. Pharmacologic Recommendations for the Initial Management of Hand Osteoarthritis (OA)a

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The ACR conditionally recommends that health professionals should use one or more of the following:
  • Topical capsaicin
  • Topical NSAIDs, including trolamine salicylate
  • Oral NSAIDs, including COX-2 selective inhibitors
  • Tramadol
The ACR conditionally recommends that health professionals should NOT use the following:
  • Intraarticular therapies
  • Opioid analgesics
The ACR conditionally recommends:
  • That persons age ≥75 years should use topical rather than oral NSAIDs.
  • In persons age <75 years, the ACR expresses no preference for using topical rather than oral NSAIDs.

No strong recommendations were made for the pharmacologic management of hand aOA.

Knee:

Table 3. Nonpharmacologic Recommendations for the Management of Knee Osteoarthritis (OA)

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The ACR strongly recommends that patients with knee OA should do the following:
  • Participate in cardiovascular (aerobic) and/or resistance land-based exercise
  • Participate in aquatic exercise
  • Lose weight (for persons who are overweight)
The ACR conditionally recommends that patients with knee OA should do the following:
  • Participate in self-management programs
  • Be instructed in the use of thermal agents
  • Receive manual therapy in combination with supervised exercise
  • Receive walking aids, as needed
  • Participate in tai chi programs
  • Receive psychosocial interventions
  • Use medially directed patellar taping
  • Wear medially wedged insoles if they have lateral compartment OA
  • Be treated with traditional Chinese acupuncturea
  • Wear laterally wedged subtalar strapped insoles if they have medial compartment OA
  • Be instructed in the use of transcutaneous electrical stimulationa
The ACR has no recommendations regarding the following:
  • Participation in balance exercises, either alone or in combination with strengthening exercises
  • Receiving manual therapy alone
  • Wearing knee braces
  • Wearing laterally wedged insoles
  • Using laterally directed patellar taping
These modalities are conditionally recommended only when the patient with knee aOA has chronic moderate to severe pain and is a candidate for total knee arthroplasty but either is unwilling to undergo the procedure, has comorbid medical conditions, or is taking concomitant medications that lead to a relative or absolute contraindication to surgery or a decision by the surgeon not to recommend the procedure.

Table 4. Pharmacologic Recommendations for the Initial Management of Knee Osteoarthritis (OA)a

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The ACR conditionally recommends that patients with knee OA should use one of the following:
  • Acetaminophen
  • Tramadol
  • Oral or Topical NSAIDs
  • Intraarticular corticosteroid injections
The ACR conditionally recommends that patients with knee OA should NOT use the following:
  • Chondroitin sulfate
  • Topical capsaicin
  • Glucosamine
The ACR has no recommendation regarding:
  • the use of intraarticular hyaluronates, duloxetine, and opioid analgesics

No strong recommendations were made for the initial pharmacologic management of knee aOA.

Hip:

Table 5. Nonpharmacologic Recommendations for the Management of Hip Osteoarthritis (OA)

Having trouble viewing table?
The ACR strongly recommends that patients with hip OA should do the following:
  • Participate in cardiovascular (aerobic) and/or resistance land-based exercise
  • Participate in aquatic exercise
  • Lose weight (for persons who are overweight)
The ACR conditionally recommends that patients with hip OA should do the following:
  • Participate in self-management programs
  • Receive manual therapy in combination with supervised exercise
  • Receive psychosocial interventions
  • Be instructed in the use of thermal agents
  • Receive walking aids, as needed
The ACR has no recommendations regarding the following:
  • Participation in balance exercises, either alone or in combination with strengthening exercises
  • Participation in tai chi
  • Receiving manual therapy alone

Table 6. Pharmacologic Recommendations for the Initial Management of Hip Osteoarthritis (OA)a

Having trouble viewing table?
The ACR conditionally recommends that patients with hip OA should use one of the following:
  • Acetaminophen
  • Tramadol
  • Oral NSAIDs
  • Intraarticular corticosteroid injections
The ACR conditionally recommends that patients with hip OA should NOT use the following:
  • Chondroitin sulfate
  • Glucosamine
The ACR has no recommendation regarding the use of the following:
  • Topical NSAIDs
  • Intraarticular hyaluronate injections
  • Duloxetine
  • Opioid analgesics

No strong recommendations were made for the initial pharmacologic management of hip aOA.

Figure 1. Knee OA: Overview of Management