A systematic review of recommendations and guidelines for the management of osteoarthritis: The Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative.
Osteoarthritis (OA) is a chronic condition becoming more prevalent with aging and increasing prevalence of obesity. 88% of those reporting arthritis had at least one other physical or mental comorbidity (mean of 2.4 disorders). Numerous guidelines for OA management exist. The aim was to review and critically evaluate existing OA management guidelines. 188 articles were reviewed and a total of 16 articles were included.
For non-pharmacologic modalities, self- management programs and education, exercise, weight loss and walking aids as indicated were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA.
Pharmacologic modalities included acetaminophen/paracetamol (first line) and NSAIDs (second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. However, controversy remains about acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin.
There is not a lack of quality guidelines, but rather a deficit in dissemination and implementation of recommendations. Future efforts should focus on optimizing implementation in primary care settings. > From: Nelson et al., Semin Arthritis Rheum (2013) (Epub ahead of print). All rights reserved to Elsevier Inc.
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