The American College of Rheumatology (ACR) and the Arthritis Foundation have provided new evidence-based guidelines for the management of osteoarthritis (OA) of the hands, hip and knees, updating previous ACR recommendations from 2012. The new guidelines include strong recommendations for exercise, self-efficacy and self-management programmes, as well as oral NSAIDs.

Credit: DR P. MARAZZI/Science Photo Library

Unlike the previous 2012 recommendations, which relied primarily on externally performed systematic reviews and meta-analyses, the development of the new guidelines included a comprehensive systematic literature review. “We had the same team working on the entire literature review producing one methodologically consistent meta-analysis of all of the relevant literature,” explains corresponding author Sharon Kolasinski.

The quality of the evidence was rated using Grading of Recommendations Assessment, Development and Evaluation methodology. “One innovation of our process compared to the last guideline was the convening of a patient panel who reviewed the evidence report and commented on all of the interventions considered,” notes Kolasinski. “The patients involved had a very broad personal experience with many of the interventions and were invaluable in contributing their perspective, particularly on controversial interventions.”

The voting panel, consisting of rheumatologists, an internist, physical and occupational therapists, and two representatives from the patient panel, made conditional recommendations for and against various therapies for OA, including educational, behavioural, psychosocial, physical, mind–body and pharmacological therapies.

“The biggest impact to practice might come from the conditional recommendation against hyaluronic acid injections,” says Kolasinski. Hyaluronic acid injections were previously conditionally recommended for use in knee OA. “The best evidence suggests that hyaluronic acid injections are equivalent to saline injections in efficacy,” she explains.

The new guidelines emphasize the importance of shared decision making

Overall, the new guidelines emphasize the importance of shared decision making between clinicians and patients and highlight gaps in our knowledge that need addressing in future studies.