Tai-Chi, Topical Capsaicin Among the New Treatment Recommendations for Osteoarthritis

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The American College of Rheumatology (ACR), in partnership with the Arthritis Foundation, has issued treatment guidelines for osteoarthritis of the hand, hip and knee. This is the first update since 2012.

New in this release is the inclusion of patients in the decision-making process, which the Arthritis Foundation described a "patient-centric guidelines."

“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 guidelines, which will be published in February in an ACR journal, emphasizes the adoption of basic therapeutic treatments which were strongly recommended. These include: weight loss; self-management programs to build fitness skills and exercise goal‑setting. Previously consider conditions recommendations, the following were upgraded to “strong” recommendations: mind-body approaches such as tai-chi; topical NSAIDs for knee and hand osteoarthritis; oral NSAIDs and intra-articular steroids for knee and hip osteoarthritis.

Other recommendations include:

• A new conditional recommendation for balance exercises for knee and hip osteoarthritis and duloxetine for knee osteoarthritis.

• A conditional recommendation for using topical capsaicin in patients with knee osteoarthritis (previously conditional against).

• New conditional recommendations for using yoga, cognitive behavioral therapy, radiofrequency ablation and kinesiotaping for first carpometacarpal and knee osteoarthritis.

• A conditional recommendation against using manual therapy with exercise for knee and hip osteoarthritis (previously was conditionally for usage).

• A strong recommendation against transcutaneous electric nerve stimulation for knee and hip osteoarthritis (previously was a conditional recommendation).

• A new conditional recommendation against using intra-articular hyaluronic acid injections in first carpometacarpal and knee osteoarthritis.

• A new strong recommendation against using hyaluronic acid injections in patients with hip osteoarthritis.

REFERENCE:  Sharon L. Kolasinski, Tuhina Neogi, Marc C. Hochberg, et al. "2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee." January 2020. Arthritis Care and Research. DOI:10.1002/acr.24131