It has taken 10 years but finally the American College of Rheumatology (ACR) has updated it’s osteoarthritis treatment guidelines- at least for the hip, knee and hand. This is the first time it has issued osteoarthritis treatment guidelines for the hand which is pretty amazing considering how common hand osteoarthritis is and it never ceases to amaze me that no guidelines are issued for osteoarthritis in any other joint. In the mean time all we can do is assume the advice is okay for other joints. My advice is to follow the same osteoarthritis treatment guidelines for all joints with osteoarthritis and put a call into the researchers to do research on other joints, not just hips and knees!
Arthritis Today reported this on the new osteoarthritis treatment guidelines
“The aim is to provide rheumatologists, general practitioners and patients a guide to proven, effective treatments based on the best available evidence, says Marc C. Hochberg, MD, professor of medicine at the University of Maryland School of Medicine in Baltimore and chair of the ACR’s OA guideline committee.
The aim of the study was:
“To formulate the ACR recommendations, a panel of experts – including academic and practicing rheumatologists, primary care physicians, physiatrists, geriatricians, orthopaedic surgeons, and occupational and physical therapists – evaluated more than 50 drug and non-drug treatments used in the U.S. and Canada to manage OA, assessing their effectiveness as well as the quality of evidence supporting them.
In cases where the panel determined evidence was high-quality – for example, because it was based on several randomized, controlled trials – the recommendation (either for or against) was rated “strong.” Weaker evidence – for example, because the benefits of a treatment did not clearly outweigh the potential risks, or because the quality of the studies was inferior – led to a “conditional” rating. And in cases where evidence was insufficient, the panel chose not to issue a recommendation.
Approval of the recommendations was consensus-based, requiring agreement among at least 75 percent of panel members.”
The strongest recommendations in the new hip and knee osteoarthritis treatment guidelines were for land and aquatic based exercises and for weight loss when required.
However some studies have shown that
“Only land-based exercise showed some improvement in pain and muscle strength compared with the control group, while no clinical benefits were detectable after aquatic exercise compared with the control group.”
Arthritis Today also reported
“Sharon Kolasinski, MD, professor of medicine at Cooper Medical School in Camden, N.J., who was not involved in drafting the recommendations, says the emphasis on exercise is important.
“People with OA exercise less than the general population, yet exercise is critical for strength, flexibility and balance. There is good data showing that pain is reduced, functioning increased and surgery delayed with an exercise program,” she says. “No intervention can halt the progression of OA, but exercise and weight loss are particularly important [for quality of life].”.
The interesting thing is that no drug therapy was strongly supported by the ACR as part of these new osteoarthritis treatment guidelines. They did conditionally support the use of acetaminophen, oral NSAIDs (non-steroidal anti inflammatory drugs), the synthetic opioid tramadol and corticosteroid joint injections. Although, as I reported a while back, they strongly support the use of topical NSAIDs rather than oral in the over 75 age group.
This again is where I fail to see the logic. Osteoarthritis is, by their own definition, a NON INFLAMMATORY arthritis. It is the effect of the joint dysfunction that causes inflammation in the muscles, tendons and ligaments and they have just strongly recommended that exercises are used to control this! Surely with the side effects of these drugs (which are well documented) and with strong recommendation for an alternative therapy with no life threatening side effects, it is about time they stopped prescribing them and started prescribing decent exercise programmes instead.
The new osteoarthritis treatment guidelines also conditionally recommended tai chi, acupuncture, TENS (transcutaneous electrical nerve stimulation) or intra-articular hyaluronate injections for the knee but there was not enough research to recommend them for the hip. I suspect they would work equally well though.
Controversially the new osteoarthritis treatment guidelines did not include the use of glucosamine sulphate and chondroitin. This is because
“The body of evidence from recent North American studies … failed to demonstrate efficacy for [these supplements] greater than placebo, so the panel felt the evidence did not support their use,” explains Dr. Hochberg, adding that forms of the supplements tested in the U.S. are different from those in Europe found to be safe and effective.”
That seems a bit daft to me. Surely good research is good research, no matter which continent it was carried out on and if the European glucosamine sulphate has been found to help then surely the USA should be testing and producing it?
New Osteoarthritis Treatment Guidelines for the Hand
There was no strong recommendations in the new hand osteoarthritis treatment guidelines due to the lack of research. Why there is so much research put into hips and knees and the hands continue to be neglected beats me. Osteoarthritis in any joint affects the sufferers quality of life and it’s not as if hand osteoarthritis is rare!
They did however make the following conditional recommendations:
“Conditional recommendations for initial non-drug treatment include a physician assessment of the patient’s ability to perform daily tasks, as well as use of assistive devices as needed and splints for thumb OA.
Conditional drug recommendations include oral or topical NSAIDs – topical rather than oral for patients older than 75 – as well as tramadol and capsaicin, a topical pain reliever derived from chili peppers…”
I actually think topical NSAIDs actually work better in soft tissue inflammation in the hands and feet as they are so close to the surface of the skin and oral NSAIDs have to travel via the blood stream so the delivery system may be compromised in the 50+ age group.
All in all I say these new osteoarthritis treatment guidelines are a huge improvement. I think Dr. Hochberg sums it up well saying
“It’s important for people to recognize that there are a lot of interventions available to them,” he says. “After all, we reviewed the data on 50 different modalities. If patients have a positive attitude and participate in their care, there is much that can be done.”
Until stem cell treatment is further down the line there is little we can do about the actual degeneration in our joints but we can do so much to relieve our symptoms and improve our quality of life.
I have long advocated exercises (hence the name of this website!) and it is good to see these new osteoarthritis treatment guidelines strongly agree but please make sure any programme you do is designed for you and how your osteoarthritis affects you. (For more information on how and why exercise for osteoarthritis helps please click here.)
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