Working to Develop OA Patient-Centric Guidelines

The Arthritis Foundation is proud to have partnered with the American College of Rheumatology (ACR) on the release of new guidelines for the management of osteoarthritis (OA) of the hand, knee, and hip. The guideline process included input from OA patients, which was made possible through the Arthritis Foundation and ACR partnership.

“Traditionally, the patient voice has been invoked, but not always present, as guidelines are developed,” said Guy Eakin, Senior Vice President of Scientific Strategy for the Arthritis Foundation. “Through our partnership we were able to marry the ACR rheumatology expertise with the Live Yes! patient community to pioneer a process assuring guidelines that treat patients reflect the unique perspectives of the patients who will receive them.”

The new guidelines were presented as part of the 2019 ACR/Association of Rheumatology Professionals (ARP) Annual Meeting held in Atlanta on November to discuss the process of how the guidelines were developed and the results.

“We are proud to have been involved in this work and to facilitate the important contributions of the patient partners," said Cindy McDaniel, Arthritis Foundation’s Senior Vice President of Consumer Affairs. "Their lived experiences truly helped to guide this project."

The draft guidelines include the following Strong Recommendations , for which there is strong evidence for benefits, clearly outweighing harms for almost all OA patients:

• Educational, behavioral, and psychosocial approaches:
  
  
  
  • Weight loss, especially for those with hip and knee OA.
  
  
  • Self-efficacy, self-management programs to help build skills like fitness and exercise goal‑setting, problem-solving, and positive thinking.
  
  
  
  


• Mind-body and physical approaches:
  
  
  
  • Exercise : aerobic, strengthening, neuromuscular, and aquatic exercise are all recommended.
    Note : exercise may be more effective if supervised, so patients may consider supervision by a physical therapist.
  
  
  • Tai-chi , especially for those with hip and knee OA.
  
  
  • Medical devices and aids : Use of canes (for hip and knee OA), orthotic devices, and wrist braces.
  
  
  
  


• Pharmacological approaches
  
  
  
  • Topical non-steroidal anti-inflammatory drugs (NSAIDs, especially for knees)
  
  
  • Oral NSAIDs
  
  
  • Intra-articular steroid injections (knee, hip)
  
  
  • Imaging guidance for injections (hip)
  
  
  
  

The draft guidelines include the following Conditional Recommendations , for which there is less evidence that benefits may outweigh harms, for a majority of OA patients:

• Educational, behavioral, and psychosocial approaches:
  
  
  
  • Cognitive behavioral therapy .
  
  
  
  


• Mind-body and physical approaches:
  
  
  
  • Yoga, especially for those with knee OA.
  
  
  • Balance training, especially for those with hip and knee OA.
  
  
  • Medical devices and aids : Use thermal interventions, radio‑frequency ablation (knee), medical tape, orthotic devices, acupuncture, and knee braces.
  
  
  
  


• Pharmacological approaches
  
  
  
  • Topical NSAIDs (hand)
  
  
  • Topical capsaicin (knee)
  
  
  • Intra-articular steroid injections (hand)
  
  
  • Intra-articular steroid injection over other injectables
  
  
  • Chondroitin sulfate (hand)
  
  
  • Acetaminophen
  
  
  • Duloxetine (knee)
  
  
  • Tramadol
  
  
  
  

Learn more by reading the paper containing the full list of recommendations and supporting evidence.

Aside from recruiting patients to participate in the development of these guidelines, the Arthritis Foundation also brought nine arthritis patient partners to the 2019 annual meeting to help elevate the patient voice and perspective.

The meeting was attended by close to 16,000 rheumatologists and other rheumatology healthcare professionals, researchers, fellows in training and exhibitors from more than 100 countries gathered to learn about the latest scientific advances, clinical issues, and engage in professional development.

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