ACR, Arthritis Foundation Emphasize Patient Involvement in OA Guideline Development
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The American College of Rheumatology, in partnership with the Arthritis Foundation, has released an update to its Guideline for the Management of Osteoarthritis of the Hand, Hip and Knee, for the first time adding provisions that include direct patient participation, according to a press release.
“We are proud to have been involved in this work and to facilitate the important contributions of the patient and parent partners,” Cindy McDaniel, senior vice president of consumer affairs for the Arthritis Foundation, said in the release. “Their lived experiences truly helped to guide this project.”
The 2019 guidelines were authored by a core team that identified 44 potential interventions for patients with osteoarthritis. The development team included five groups, one of which was a patient panel that helped the authors draft the recommendations that stressed patient participation and shared decision making.
“OA patients, who were recruited through a partnership with the Arthritis Foundation, were especially instrumental in emphasizing the role of shared decision making when choosing treatment options such as those with conditional recommendations,” read the press release.
The paper containing the full list of recommendations and supporting evidence is available here: https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Osteoarthritis.
After formulating the Population/Intervention/Comparison/Outcome (PICO) questions, the document was posted on the web for public comment. A subsequent literature review began with more than 8,000 articles and ultimately included 536 papers.
The new guidelines differ from the previous recommendations, which were published in 2012, in several key ways. For example, in contrast with 2012, self-efficacy and self-management are strongly, not conditionally, recommended for knee and hip OA. Other recommendations that were changed from “conditional” to “strong” include the use of tai chi for knee and hip OA, topical NSAIDs for knee and hand OA and oral NSAIDs and intra-articular steroids for knee and hip OA.
Other recommendations in the 2019 update include:
- A new conditional recommendation for balance exercises for knee and hip OA, as well as duloxetine for knee OA;
- A conditional recommendation in favor of using topical capsaicin in patients with knee OA, whereas the previous guidelines were conditionally against such treatment;
- New conditional recommendations for using yoga, cognitive behavioral therapy, radiofrequency ablation and kinesio taping for first carpometacarpal and knee OA;
- A conditional recommendation against using manual therapy with exercise for knee and hip OA, whereas the guidelines previously were conditionally in favor of usage;
- A strong — changed from conditional — recommendation against transcutaneous electric nerve stimulation for knee and hip OA;
- A new conditional recommendation against using intra-articular hyaluronic acid injections in first carpometacarpal and knee OA; and
- A new strong recommendation against using hyaluronic acid injections in patients with hip OA.
According to the press release, “Of note, exercise remains an important intervention in the updated recommendations, with a strong body of literature supporting its use for almost all patients with OA.”