25 Effective Osteoarthritis Treatments

OARSI Ranks Treatment Recommendations for Knee and Hip Osteoarthritis

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Various osteoarthritis treatments are recommended to patients with joint pain, stiffness, swelling, and other osteoarthritis symptoms. Patients are often confused by so many treatment options though -- and quite honestly, they would like to skip what doesn't work and focus on what does. Which osteoarthritis treatments are best?

Osteoarthritis Research Society International (OARSI) formed a committee (11 rheumatologists, 2 primary care physicians, 1 orthopedic surgeon, and 2 experts on evidence-based medicine from 6 countries) who performed a systematic review of treatment guidelines that existed from 1945 to January 2006 for knee and hip osteoarthritis. From the search, the committee identified 23 treatment guidelines for management of knee and hip osteoarthritis -- 6 were opinion-based, 5 were evidence-based, and 12 based on both expert opinion and research evidence. Through an arduous process that included critical appraisal of existing guidelines, systematic review of more recent evidence, and exercises to generate consensus recommendations -- ultimately 25 treatments were proclaimed "a single set of up-to-date recommendations."

Each recommended treatment was assigned an SOR (strength of recommendation) score. The SOR for each treatment was based on opinions of the guideline committee after considering research evidence for safety, effectiveness, and cost-effectiveness. The clinical expertise of the committee members helped formulate the SOR too, including such factors as their perception of patient tolerance for the treatment. The SOR is expressed as a percentage that represents the average of the committee members' SOR scores for each recommendation, where 0% is the weakest and 100% is the strongest. For example, a SOR of  97% indicates that the committee, on average, considered the efficacy, safety, and cost-effectiveness of the therapy to be very high.

OARSI emphasized that optimal treatment for osteoarthritis involves both pharmacologic (drug) and non-pharmacologic (non-drug) treatments. That was the first general recommendation. The other 24 recommendations were divided into three categories -- nonpharmacologic, pharmacologic, and surgical. Next to each recommended treatment is the SOR percentage.

11 Nonpharmacologic Modes of Treatment for Osteoarthritis


8 Pharmacologic Treatments for Osteoarthritis


5 Surgical Treatments for Osteoarthritis


Older guidelines for the treatment of osteoarthritis were developed prior to NSAIDs being scrutinized for potential heart risks (heart attack and stroke). The association of gastrointestinal side effects and heart risks has caused NSAIDs to be used less. OARSI committee members believe NSAIDs are effective anti-inflammatory drugs and that short-term use may be appropriate -- when considered on an individual basis. OARSI does not recommend NSAIDs for long-term use without considering a patient's history.

Overall, there were limitations of the guideline development by OARSI. One could point to the imbalance of doctors on the committee -- with orthopedic surgeons and primary care doctors underrepresented. Certainly one could point to the heavy subjectivity that was involved in developing a consensus. But even so, there is value in the new guidelines, especially for patients, who lack access to all of the previous guidelines that were considered by the committee.

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