Arthritis Management Recommendations

Core Interventions

• The American College of Rheumatology recommends regular exercise programs for all patients with osteoarthritis (OA) of the hand, hip, and knee, including walking, strengthening exercises, neuromuscular training, and aquatic exercise 2, 3, 4, 5
• Strong recommendation for weight loss in patients with knee and/or hip OA who are overweight or obese, as part of a comprehensive management plan 2, 3, 1, 4
• Self-efficacy and self-management programs are strongly recommended, including education about arthritis, coping strategies, and activity pacing 2, 3, 8, 9, 10

Joint-Specific Interventions

• The American College of Rheumatology strongly recommends first carpometacarpal (CMC) joint orthoses for hand arthritis management, and conditionally recommends orthoses for other hand joints and kinesiotaping for first CMC OA 2, 3, 6, 7
• Strong recommendation for tibiofemoral bracing for tibiofemoral OA, and conditional recommendation for patellofemoral bracing for patellofemoral OA 2, 3, 7
• Cane use is strongly recommended to improve mobility in patients with knee and hip OA 2, 3

Pharmacologic Management

• Topical NSAIDs are strongly recommended for knee OA, and oral NSAIDs are strongly recommended for hand, knee, and hip OA, with consideration of the lowest effective dose to minimize gastrointestinal and cardiovascular risks 3, 7, 2, 4
• Acetaminophen, duloxetine, and tramadol are conditionally recommended as second-line options for pain management in OA patients 3, 7

Additional Therapeutic Approaches

• Mind-body interventions, including yoga, cognitive behavioral therapy, and acupuncture, are conditionally recommended for OA management 3, 7, 8
• Physical modalities, such as thermal modalities, massage therapy, balance exercises, and radiofrequency ablation, are conditionally recommended for OA management 3, 7, 8

Implementation Considerations

• A treatment selection algorithm is recommended, starting with non-pharmacologic interventions, adding orthoses and topical therapies as needed, and progressing to oral medications and intraarticular injections based on patient response and joint involvement 2, 3, 9, 10
• Regular monitoring and adjustment of the treatment plan is necessary, considering the progressive nature of arthritis and potential comorbidities 3, 7, 9, 10