Osteoarthritis
Also known as: degenerative joint disease · DJD · OA
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2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
American College of Rheumatology (ACR) and Arthritis Foundation · 2019 · 2019 guideline
The ACR guideline page for osteoarthritis, hosting the current joint ACR/Arthritis Foundation guideline for hand, hip and knee osteoarthritis. The guideline spans educational, behavioural, psychosocial, physical, mind-body and pharmacological management options, graded using GRADE methodology.
- The ACR page lists the 2019 ACR/Arthritis Foundation document as the current osteoarthritis guideline with no newer version. source
- Exercise, weight management and self-management programmes are among the strongly recommended core interventions. source
- The guideline explicitly advises against several widely used options, including glucosamine and biologic injection therapies. source
2018 update of the EULAR recommendations for the management of hand osteoarthritis
European Alliance of Associations for Rheumatology (EULAR) · 2019 · 2018 update
EULAR's European recommendations for hand osteoarthritis, published in Annals of the Rheumatic Diseases. They combine non-pharmacological measures such as education, exercise, orthoses and assistive devices with pharmacological options and surgical considerations, framed around individualised, shared decision-making.
- Comprises five overarching principles and ten recommendations developed by a task force from ten European countries. source
- Topical NSAIDs are positioned as the preferred first-line drug treatment for hand osteoarthritis. source
- Conventional and biologic DMARDs are advised against for hand osteoarthritis. source
US vs EU key differences
- Scope differs: the ACR/Arthritis Foundation guideline covers hand, hip and knee osteoarthritis in a single document, whereas the European recommendations are hand-OA-specific, comprising 5 overarching principles and 10 recommendations. source
- Both sides make hand OA an exception for chondroitin: EULAR recommends chondroitin sulphate for symptom relief in hand OA, and ACR conditionally recommends it for the hand while strongly recommending against glucosamine and chondroitin for knee and hip OA. source
- Topical NSAIDs are ranked differently in hand OA: EULAR makes them the explicit first-line pharmacological choice ahead of oral NSAIDs, while the ACR rates them only conditionally for the hand (versus strongly for the knee) because most trial evidence came from knee OA. source
- Both discourage conventional and biologic DMARDs in hand osteoarthritis, and the European guideline additionally advises against routine intra-articular glucocorticoids except in painful interphalangeal disease. source
What changed recently
- US2012 recommendations → 2019 guideline2020-01-06
The guideline abandoned the stepwise treatment pyramid of 2012 in favour of combining modalities throughout the disease course, and promoted self-efficacy programmes, tai chi, topical and oral NSAIDs and intra-articular steroids from conditional to strong recommendations. Balance exercise for knee and hip OA and duloxetine for knee OA were newly added, while transcutaneous electrical nerve stimulation is now strongly recommended against on evidence of no benefit.
source ↗curation confidence 90% - EU2007 recommendations → 2018 update2018-08-28
The update restructured the guidance into five overarching principles and ten recommendations and made topical NSAIDs the preferred topical agent and the pharmacological first choice ahead of oral drugs. It also took clearer negative positions than the 2007 version, discouraging conventional and biological DMARDs in hand osteoarthritis and advising against routine intra-articular glucocorticoid injection except in limited circumstances.
source ↗curation confidence 90%
See the full update feed for changes across every system.