- 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.
Tables 1-2 Legend
|Strongly recommended against|
|Conditionally recommended against|
Table 1. Recommendations for physical, psychosocial, and mind-body approaches for the management of osteoarthritis of the hand, knee, and hip
|Self-efficacy and self-management programs|
|Cognitive behavioral therapy|
|Tibiofemoral knee braces||(Tibiofemoral)|
|Hand orthosis||(First carpometacarpal)|
|Hand orthosis||(Other joints)|
|Lateral and medial wedged insoles|
|Manual therapy with/without exercise|
|Pulsed vibration therapy|
|Transcutaneous electrical nerve stimulation|
Table 2. Recommendations for the pharmacologic management of osteoarthritis of the hand, knee, and hip
|Topical nonsteroidal antiinflammatory drugs|
|Oral nonsteroidal antiinflammatory drugs|
|Intraarticular glucocorticoid injection|
|Ultrasound-guided intraarticular glucocorticoid injection|
|Intraarticular glucocorticoid injection compared to other injections|
|Intraarticular hyaluronic acid injection||(First carpometacarpal)|
|Intraarticular botulinum toxin|
|Stem cell injection|
|Biologics (tumor necrosis factor inhibitors, interleukin-1 receptor antagonists)|
Figure 1. Recommended therapies for the management of osteoarthritisStrongly and conditionally recommended approaches to management of hand, knee, and/or hip OA are shown. No hierarchy within categories is implied in the figure, with the recognition that the various options may be used (and reused) at various times during the course of a particular patient’s disease.
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).