OBJECTIVE To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

中文翻译：

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2019 年美国风湿病学会/关节炎基金会手部、髋部和膝部骨关节炎治疗指南。

目的 美国风湿病学会 (ACR) 和关节炎基金会合作，制定骨关节炎 (OA) 综合管理循证指南，更新 2012 年 ACR 关于手、髋和膝 OA 管理的建议。方法 我们确定了 OA 中临床相关的人群、干预措施、比较对象、结果问题和关键结果。文献综述小组进行了系统的文献综述，总结了支持 OA 现有教育、行为、社会心理、身体、身心和药物疗法的益处和危害的证据。使用建议评估、制定和评估的分级方法来评估证据的质量。由风湿病学家、内科医生、物理和职业治疗师以及患者组成的投票小组就这些建议达成了共识。结果 根据现有证据，对所评估的方法提出了支持或反对的强烈或有条件的建议。强烈建议进行锻炼、超重或肥胖的膝关节和/或髋关节骨关节炎患者的减肥、自我效能和自我管理计划、太极拳、手杖使用、第一腕掌关节骨关节炎的手部矫形器、胫股骨支具治疗胫股骨膝关节 OA、局部非甾体抗炎药 (NSAID) 治疗膝关节 OA、口服 NSAID 以及关节内糖皮质激素注射治疗膝 OA。有条件的建议包括平衡练习、瑜伽、认知行为疗法、首次 CMC OA 的运动贴扎、第一 CMC 关节以外的手关节矫形器、髌股膝 OA 的髌股支具、针灸、热疗法、膝关节 OA 的射频消融、局部治疗非甾体抗炎药、关节内类固醇注射和硫酸软骨素治疗手部 OA，局部辣椒素治疗膝部 OA、对乙酰氨基酚、度洛西汀和曲马多。结论 本指南为临床医生和患者制定 OA 治疗决策提供指导。临床医生和患者应共同决策，考虑患者的价值观、偏好和合并症。这些建议不应被用来限制或拒绝接受治疗。