American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee
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Objective: To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA. Methods: A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence‐based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee. Results: Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self‐management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. Conclusion: These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA.
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The American College of Rheumatology (ACR) in 2012 recommended paracetamol as a preferred oral default.
“and as a preferred oral default by the American College of Rheumatology (ACR) in 2012 [ 48 ].”
From Paracetamol: A History of Assumptions, Errors, and Evidence Reversals in Pain Management (2026) · cites this paper as [48]
The pharmacologic recommendations for initial knee OA management list acetaminophen (paracetamol) as one of several conditionally recommended options, alongside oral NSAIDs and other treatments; the hip OA table does the same. The paper does not designate it the preferred oral default, and its hand OA recommendations do not list it. (LLM, conf=0.88)
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- Authors
- Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., Guyatt, G., McGowan, J., Towheed, T., Welch, V., Wells, G., & Tugwell, P.
- Affiliations
- University of Maryland, Baltimore (US)
- University of California, Los Angeles (US)
- University of Ottawa (CA)
- McMaster University (CA)
- Queen's University (CA)
- Corresponding author
- Hochberg, Marc C.
- ORCID
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2012-03-27
- Volume
- 64
- Issue
- 4
- Pages
- 465-474
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- OpenAlex
- W2036491373
- Cited by
- 3,068
- References
- 48
- Citations by year
- 2026: 64 · 2025: 94 · 2024: 138 · 2023: 118 · 2022: 168 · 2021: 213 · 2020: 310 · 2019: 301 · 2018: 308 · 2017: 262 · 2016: 267 · 2015: 364 · 2014: 225 · 2013: 174 · 2012: 54
- FWCI
- 199.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Ottawa
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Keywords
- osteoarthritis, hand osteoarthritis, hip osteoarthritis, knee osteoarthritis, non-pharmacological treatment, pharmacotherapy, joint protection, assistive devices, topical NSAIDs, tramadol, capsaicin, exercise therapy, weight loss, manual therapy, Tai Chi, self-management program, intra-articular corticosteroids, hyaluronic acid injection, duloxetine, opioid analgesics, total joint arthroplasty
- MeSH terms
- Anti-Inflammatory Agents, Non-Steroidal, Humans, Osteoarthritis, Societies, Medical, Tramadol, United States, Osteoarthritis, Hip, Weight Loss, Osteoarthritis, Knee, Hand Joints, Resistance Training
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