OARSI Issues New Guidelines for Knee OA

The Osteoarthritis Research Society International has given NSAIDs, corticosteroid injections, and canes the nod as appropriate for knee OA. Other interventions, including glucosamine/chondroitin and intra-articular hyaluronic acid, are judged of uncertain benefit.

McAlindon TE, Bannuru RR, Sullivan MC, et al., OARSI guidelines for the non-surgical management of knee Osteoarthritis.Osteoarthritis and Cartilage. January 29, 2014. 1e25 [e-pub ahead of print]

Most patients with knee osteoarthritis (knee OA) can safely use non-steroidal anti-inflammatory drugs (NSAIDs) or canes as well as corticosteroid injections, according to just-published guidelines from OA Research Society International (OARSI).

But OARSI’s update to its 2010 guidelines for nonsurgical management of knee OA does not recommend medications to prevent bone loss (such as risedronate) or electrotherapy treatments. Intra-articular hyaluronic acid (IAHA) injections also did not get a thumbs-up.

For the update, the 14-member multi-national panel reviewed and rated evidence for 29 treatment modalities, ranging from NSAIDs to rose hips.

OARSI says non-surgical interventions, including land or aqua exercise, strength-training, weight loss, and self-management techniques are appropriate for everyone with OA.

For people with knee OA (or subtypes of OA in other joints like the hips and spine) who have no other health concerns, such as diabetes or cardiovascular disease, the panel supports:

Assistive devices like canes (only knee OA)
Topical NSAIDs
Intra-articular corticosteroids
Acetaminophen (e.g., paracetamol)
Capsaicin (for knee OA)
Duloxetine
Oral NSAIDs (both COX-2 selective and non-selective)

IAHA injections joined glucosamine, chondroitin, avocado and soy oil, rose hips, and opioids as interventions of “uncertain” benefit for OA of the knee only. “Inconsistent conclusions among the meta-analyses and conflicting results regarding IAHA’s safety influenced panel votes,” says the report.

Other interventions deemed of uncertain benefit for knee OA and inappropriate for multijoint RA are transcutaneous electrical nerve stimulation (TENS) and ultrasound.

Patients with knee OA who have co-morbid health concerns can use topical but not oral NSAIDs and should avoid duloxetine.

Gastroprotection (e.g., proton pump inhibitors) was recommended only for OA patients with high co-morbidity risks taking COX-2 selective NSAIDs.

Those with multijoint OA may take COX-2 inhibitors or duloxetine but not acetaminophen -- and may try thermal or mineral water spa baths (balneotherapy).