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 Legend
Figure 1. Recommended therapies for the management of osteoarthritis
Strongly 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).
Figure 2A. Physical, psychosocial, and mind-body therapies recommended againsta
Figure 2B. Pharmacologic therapies recommended against
