OARSI releases recommendations for knee and hip osteoarthritis treatment

MT. LAUREL, N.J. The Osteoarthritis Research Society International, a non-profit organization dedicated to promoting and encouraging fundamental and applied research, on Tuesday released a host of treatment recommendations for knee and hip osteoarthritis that included the chronic use of acetaminophen, short-term use of non-steroidal anti-inflammatory drugs, topical use of ingredients like capsaicin and supplementation with glucosamine and chondroitin, among other recommendations.

All told, the society released 25 evidence-based, expert-consensus recommendations that appear in the February issue of Osteoarthritis and Cartilage.

“What the committee did was take the scientifically proven commonalities it found in the international literature, evaluate the level of scientific evidence, propose a strength of recommendation for each modality, and condense them into one comprehensive ‘playbook’ of what works,” stated OARSI president Steve Abramson, director of Rheumatology and professor of Medicine at New York University School of Medicine.

“Our goal was to make these guidelines as simple as possible so that healthcare providers could determine which therapies would be most useful for an individual patient,” added Francis Berenbaum, president-elect of OARSI and a faculty member in the Department of Rheumatology at Pierre & Marie Curie University, APHP Saint-Antoine Hospital in Paris.

Nearly all of the previous guidelines were created before the recent discussion about the potential cardiovascular risks of NSAIDs took place. In recent years, there has been a decline in the use of NSAIDs, primarily due to their potential for causing gastrointestinal side effects and the perceived cardiovascular risks associated with these drugs, the Society stated.

However, members of the OARSI committee found that NSAIDs are often effective pain relievers and their short-term use should be considered on a case-by-case basis and not as a long-term option.

“As a consequence of the confusion over NSAIDs, some people may not be getting the care they need for pain,” Abramson said.

• Acetaminophen (up to 4 g/day) can be an effective initial oral analgesic for treatment of mild to moderate pain in patients with knee or hip OA;
• In patients with symptomatic hip or knee OA, NSAIDs should be used at the lowest effective dose but their long-term use should be avoided if possible. In patients with increased GI risk, either a COX-2 selective agent or a non-selective NSAID with co-prescription of a PPI or misoprostol for gastroprotection may be considered, but NSAIDs, including both non-selective and COX-2 selective agents, should be used with caution in patients with CV risk factors;
• Topical NSAIDs and capsaicin can be effective as adjunctives and alternatives to oral analgesic/anti-inflammatory agents in knee OA;
• Treatment with glucosamine and/or chondroitin sulfate may provide symptomatic benefit in patients with knee OA. If no response is apparent within 6 months treatment should be discontinued;
• In patients with symptomatic knee OA glucosamine sulfate and chondroitin sulfate may have structure-modifying effects while diacerein may have structure-modifying effects in patients with symptomatic OA of the hip.

The guideline committee was made up of experts from six countries, including 11 rheumatologists, two primary care physicians, one orthopedic surgeon and two experts on evidence-based medicine.