Osteoarthritis, the most common form of arthritis, affects between 30 million and 40 million people in the United States. It usually appears in patients as joint pain that can limit physical activity and may lead to disability. The American College of Rheumatology has updated its more-than-a-decade-old recommendations for hip and knee osteoarthritis and developed new recommendations for hand osteoarthritis. The recommendations are aimed at improving the treatment of patients with these forms of osteoarthritis.
“The biggest challenge in managing people with osteoarthritis is convincing them that there is actually something we can do for them,” says Marc C. Hochberg, MD, MPH, chair of the task force that developed the recommendations, and professor of medicine, epidemiology and public health, University of Maryland School of Medicine, Baltimore.
The recommendations increase the emphasis on non-drug treatments for patients with osteoarthritis. “Part of this is because of the increased number of studies in the past decade that have examined the non-drug treatments, particularly different kinds of exercise, as well as some of the therapies originating from integrative medicine, such as traditional Chinese acupuncture and tai chi,” says Dr. Hochberg.
Dr. Hochberg adds that many patients are concerned about taking medications known to be associated with side effects, especially when the side effects have been publicized in the news. The side effects of some medications can range from stomach upset to cardiovascular problems to liver and kidney damage.
Both factors led the panel to specifically include non-drug treatments in the recommendations. “In each of the sections of this report, we start off with non-drug treatments and then go through them in terms of ‘strong’ recommendations, ‘conditional’ recommendations and things which are not recommended,” says Dr. Hochberg.
The task force used a rigorous system to review and rate scientific studies and to develop recommendations based on evidence as much as possible. Strongly recommended therapies, such as exercise for patients with knee or hip osteoarthritis, have a large database of well-known studies that show a moderate-to-large benefit with a good safety record in those receiving the therapy, compared to those without the therapy.
The task force recommends that drug-based therapies supplement non-drug therapies and that drug treatments be tailored to the patient’s health. “If patients have no other medical conditions except for osteoarthritis and they’re not on any other medications that might interact with drugs for osteoarthritis, then one course of treatment would be recommended,” says Dr. Hochberg. “On the other hand, if the patient has other conditions, such as hypertension, diabetes, coronary artery disease, there would be another approach to drug therapy.”
Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. “American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.” Arthritis Care & Research. Published online March 27, 2012. Volume 64, Issue 4, pages 465-474, April 2012. DOI: 10.1002/acr.21596