Arthroscopy no longer Recommended for Knee OA: American College of Rheumatology (ACR)
The American College of Rheumatology has issued (April 2012) new
recommendations for initial treatment of knee hip & hand
osteoarthritis, according to an Arthritis Today report.
The recommendations were updated to take into account the latest studies and
better ways to weigh medical evidence developed since the last recommendations
were issued in 2000. Important new additions (aside from the hand OA
recommendations) include recommendations on the use of
glucosamine,
chondroitin sulfate, opioids and topical nonsteroidal anti-inflammatory drugs,
or NSAIDs.
The recommendations were updated to take into account the latest studies and
better ways to weigh medical evidence developed since the last recommendations
were issued in 2000. Important new additions (aside from the hand OA
recommendations) include recommendations on the use of glucosamine, chondroitin
sulfate, opioids and topical nonsteroidal anti-inflammatory drugs, or NSAIDs.
Treatment Guidelines for Hip and Knee OA
Two of the strongest recommendations are:
Exercise is critical for
strength,
flexibility and
balance.
There is good data showing that pain is reduced, functioning increased and
surgery delayed with an
exercise
program.
Medication:
-
For knee OA in patients older than 75 years old, the panel strongly
recommends the use of topical rather than oral NSAIDs � a new
addition to the recommendations. As they are applied to the
skin,
topicals are thought to cause less stomach bleeding and fewer other side
effects than oral NSAIDs; people older than 75 are at higher risk for
developing these complications.
-
For younger people at high risk of gastrointestinal side effects, the
panel recommends the COX-2 inhibitor celecoxib, or Celebrex,
which was designed to protect the stomach, or a traditional NSAID along with
a stomach-protective drug, such as a proton-pump inhibitor, a class of drug
that includes esomeprazole, or Nexium, or omeprazole, or
Prilosec.
-
And for people who don�t respond to other treatments and aren�t
candidates for joint replacement, the panel strongly endorses opioids
such as hydrocodone, but cautions that doctors who prescribe them should
follow guidelines established by the American Pain Society and the American
Academy of Pain Medicine.
The panel - including academic and practicing rheumatologists, primary
care physicians, physiatrists, geriatricians, orthopaedic surgeons, and
occupational and physical therapists conditionally recommends against using
chondroitin sulfate and glucosamine for knee and hip OA. The ACR withheld
judgment on the supplements in 2000.
Tai chi, acupuncture, TENS (transcutaneous electrical nerve stimulation) or
intra-articular hyaluronate injections were recommended as conditional treatment
options for knee OA.
Treatment Guidelines for Hand OA
 For
hand OA, the panel recommends that patients should be seen by a medical
professional to evaluate their ability to perform activities of daily living, to
offer instruction on the use of joint protection techniques and thermal
modalities, and to provide assistive devices and joint splints.
- Use of assistive devices
- Use of splints for thumb OA.
- Drug recommendations include oral or topical NSAIDs � topical rather
than oral for patients older than 75 �
- Tramadol and capsaicin, are recommended as topical pain reliever
derived from chili peppers, no longer recommended for knee and hip pain.
Unlike previous guidelines, these recommendations do not include a sequence
of subsequent interventions when patients fail to respond adequately to initial
therapies
Ref:
Dated 02 May 2012
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