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Content Update

November 03, 2021

Network Meta-Analysis of the Effectiveness and Safety of NSAIDs and Opioids for Knee and Hip Osteoarthritis: A meta-analysis of randomized trials involving at least 100 patients each was conducted to assess the effectiveness and safety of various nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen for treatment of pain associated with knee and hip osteoarthritis (OA). Diclofenac 150 mg/day and etoricoxib 60 mg/day (not available in the U.S.) were the most effective treatments to reduce pain, and topical diclofenac (at any dose used) had the largest effect on pain and physical function for knee OA with a better safety profile than oral diclofenac. Opioids (including tramadol) and acetaminophen were less effective than oral NSAIDs or topical diclofenac, and opioids had a worse safety profile than the other treatments evaluated.

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 ...

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