Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2020 Feb;72(2):220-233.
doi: 10.1002/art.41142. Epub 2020 Jan 6.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee

Sharon L Kolasinski  1 , Tuhina Neogi  2 , Marc C Hochberg  3 , Carol Oatis  4 , Gordon Guyatt  5 , Joel Block  6 , Leigh Callahan  7 , Cindy Copenhaver  8 , Carole Dodge  9 , David Felson  2 , Kathleen Gellar  10 , William F Harvey  11 , Gillian Hawker  12 , Edward Herzig  13 , C Kent Kwoh  14 , Amanda E Nelson  7 , Jonathan Samuels  15 , Carla Scanzello  1 , Daniel White  16 , Barton Wise  17 , Roy D Altman  18 , Dana DiRenzo  19 , Joann Fontanarosa  20 , Gina Giradi  20 , Mariko Ishimori  21 , Devyani Misra  2 , Amit Aakash Shah  22 , Anna K Shmagel  23 , Louise M Thoma  7 , Marat Turgunbaev  22 , Amy S Turner  22 , James Reston  20
Affiliations
Practice Guideline

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee

Sharon L Kolasinski et al. Arthritis Rheumatol. 2020 Feb.

Erratum in

Abstract

Objective: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.

Methods: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations.

Results: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol.

Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Recommended therapies for the management of osteoarthritis (OA). 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. *= 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. ** = Knee brace recommendations: tibiofemoral (TF) brace for TF OA (strongly recommended), patellofemoral (PF) brace for PF OA (conditionally recommended). *** = Fland 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). RFA = radiofrequency ablation; NSAIDs = nonsteroidal antiinflammatory drugs; IA = intraarticular.
Figure 2.
Figure 2.
Therapies recommended against (physical, psychosocial, and mind-body approaches [A] and pharmacologic approaches [B] in the management of hand, knee, and/or hip osteoarthritis. No hierarchy within categories is implied in the figure. TENS = transcutaneous electrical nerve stimulation; TNF = tumor necrosis factor; IL-1 = interleukin-1; PRP = platelet-rich plasma; IA = intraarticular.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cisternas MG, Murphy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey. Arthritis Care Res (Hoboken) 2016;68:574–80. - PMC - PubMed
    1. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:P1603–58. - PMC - PubMed
    1. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum 2008;59:1207–13. - PMC - PubMed
    1. Murphy LB, Helmick CG, Schwartz TA, Renner JB, Tudor G, Koch GG, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage 2010;18:1372–9. - PMC - PubMed
    1. Qin J, Barbour KE, Murphy LB, Nelson AE, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic hand osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Rheumatol 2017;69:1204–12. - PMC - PubMed

Publication types