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Content Update

March 28, 2020

Updated Guideline for Management of Osteoarthritis of the Hand, Hip, and Knee: Focus on Pharmacologic Approaches: A panel of the American College of Rheumatology (ACR) and the Arthritis Foundation updated the 2012 ACR recommendations for nonpharmacologic and pharmacologic management of osteoarthritis (OA) of the hand, hip, and knee. Regarding drug therapy, the panel made strong recommendations for topical NSAIDs for knee OA; oral NSAIDs for hand, knee, and hip OA; and intraarticular (IA) glucocorticoid injections for knee and hip OA. The panel made conditional recommendations for topical NSAIDs, IA corticosteroids, and chondroitin sulfate for hand OA; topical capsaicin for knee OA; and acetaminophen, duloxetine, and tramadol for all three anatomic sites. The guideline strongly recommends against use of glucosamine and/or chondroitin except in hand OA.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiologic mechanisms involved in the development of osteoarthritis (OA).

  2. Identify risk factors associated with OA.

  3. Recognize the clinical presentation of OA.

  4. Determine the goals of therapy for individual patients with OA.

  5. Formulate a rational nonpharmacologic plan for patients with OA.

  6. Recommend a pharmacologic plan for treating OA, taking into consideration patient-specific factors.

  7. Develop monitoring parameters to assess effectiveness and adverse effects of pharmacotherapy for OA.

  8. Modify an unsuccessful treatment strategy for OA.

  9. Deliver effective patient counseling, including lifestyle modifications and drug therapy, to facilitate effective and safe management of OA.

INTRODUCTION

image Osteoarthritis is the most common form of arthritis and is strongly related to age. Weight-bearing joints (eg, hips, knees) are most susceptible, but non–weight-bearing joints, especially hands, may be involved. OA causes tremendous morbidity and financial burden because of its high prevalence and effect on joints critical for daily functioning.1 OA is the leading cause of chronic mobility disability and the most common reason for total-hip and total-knee replacement.2

EPIDEMIOLOGY AND ETIOLOGY

Approximately 27 million Americans have signs and symptoms of OA.3 OA is more common in females and older persons, affecting an estimated 10% of men and 18% of women over age 60 years. Approximately 7% of Americans experience daily symptomatic hand OA, 6% experience daily symptomatic knee OA, and 3% experience daily symptomatic hip OA.3 Hip OA occurs more frequently in men.4 However, women tend to have more generalized disease and joint inflammation. Some patients can develop bony enlargements of the hands, called Bouchard nodes or Heberden nodes, in the absence of inflammation. The prevalence of OA in African Americans is similar to whites, but African Americans often experience more severe and disabling disease.

PATHOPHYSIOLOGY

OA is characterized by damage to diarthrodial joints and joint structures (Figure 58–1). The pathophysiology is multifactorial and ...

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