Key Points
- Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, and is a leading cause of disability among older adults.
- The knees, hips and hands are the most commonly affected appendicular joints.
- OA is characterized by pathology involving the whole joint, including cartilage degradation, bone remodeling, osteophyte formation, and synovial inflammation, leading to pain, stiffness, swelling, and loss of normal joint function.
Treatment
Tables 1-2 Legend
Strongly recommended |
Conditionally recommended |
Strongly recommended against |
Conditionally recommended against |
No recommendation |
Table 1. Recommendations for physical, psychosocial, and mind-body approaches for the management of osteoarthritis of the hand, knee, and hip
Intervention | Joint | ||
---|---|---|---|
Hand | Knee | Hip | |
Exercise | |||
Balance training | |||
Weight loss | |||
Self-efficacy and self-management programs | |||
Tai chi | |||
Yoga | |||
Cognitive behavioral therapy | |||
Cane | |||
Tibiofemoral knee braces | (Tibiofemoral) | ||
Patellofemoral braces | (Patellofemoral) | ||
Kinesiotaping | (First carpometacarpal) | ||
Hand orthosis | (First carpometacarpal) | ||
Hand orthosis | (Other joints) | ||
Modified shoes | |||
Lateral and medial wedged insoles | |||
Acupuncture | |||
Thermal interventions | |||
Paraffin | |||
Radiofrequency ablation | |||
Massage therapy | |||
Manual therapy with/without exercise | |||
Iontophoresis | (First carpometacarpal) | ||
Pulsed vibration therapy | |||
Transcutaneous electrical nerve stimulation |
Table 2. Recommendations for the pharmacologic management of osteoarthritis of the hand, knee, and hip
Intervention | Joint | ||
---|---|---|---|
Hand | Knee | Hip | |
Topical nonsteroidal antiinflammatory drugs | |||
Topical capsaicin | |||
Oral nonsteroidal antiinflammatory drugs | |||
Intraarticular glucocorticoid injection | |||
Ultrasound-guided intraarticular glucocorticoid injection | |||
Intraarticular glucocorticoid injection compared to other injections | |||
Acetaminophen | |||
Duloxetine | |||
Tramadol | |||
Non-tramadol opioids | |||
Colchicine | |||
Fish oil | |||
Vitamin D | |||
Bisphosphonates | |||
Glucosamine | |||
Chondroitin sulfate | |||
Hydroxychloroquine | |||
Methotrexate | |||
Intraarticular hyaluronic acid injection | (First carpometacarpal) | ||
Intraarticular botulinum toxin | |||
Prolotherapy | |||
Platelet-rich plasma | |||
Stem cell injection | |||
Biologics (tumor necrosis factor inhibitors, interleukin-1 receptor antagonists) |
Figure 1. Recommended therapies for the management of osteoarthritis
a Exercise for knee and hip OA could include walking, strengthening, neuromuscular training, and aquatic exercise, with no hierarchy of one over another. Exercise is associated with better outcomes when supervised.
b Knee brace recommendations: tibiofemoral (TF) brace for TF OA (strongly recommended), patellofemoral (PF) brace for PF OA (conditionally recommended).
c Hand orthosis recommendations: first carpometacarpal (CMC) joint neoprene or rigid orthoses for first CMC joint OA (strongly recommended), orthoses for joints of the hand other than the first CMC joint (conditionally recommended).