2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
Open accessAbstract
Objective: To develop an evidence‐based guideline for the comprehensive management of osteoarthritis ( OA ) as a collaboration between the American College of Rheumatology ( ACR ) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA . Methods: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA . A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind‐body, and pharmacologic therapies for OA . Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Results: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self‐efficacy and self‐management programs, tai chi, cane use, hand orthoses for first carpometacarpal ( CMC ) joint OA , tibiofemoral bracing for tibiofemoral knee OA , topical nonsteroidal antiinflammatory drugs ( NSAID s) for knee OA , oral NSAID s, and intraarticular glucocorticoid injections for knee OA . Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA , orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA , acupuncture, thermal modalities, radiofrequency ablation for knee OA , topical NSAID s, intraarticular steroid injections and chondroitin sulfate for hand OA , topical capsaicin for knee OA , acetaminophen, duloxetine, and tramadol. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA . Clinicians and patients should engage in shared decision‐making that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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The updated ACR/Arthritis Foundation guidelines downgraded paracetamol to a conditional recommendation in 2019.
“This standard was explicitly reversed when the updated ACR/Arthritis Foundation guidelines downgraded paracetamol to a conditional recommendation in 2019 [ 28 ]”
From Paracetamol: A History of Assumptions, Errors, and Evidence Reversals in Pain Management (2026) · cites this paper as [28]
The 2019 guideline’s Pharmacologic management section conditionally recommends acetaminophen (paracetamol) for knee, hip, and hand osteoarthritis. The passages establish the 2019 recommendation but do not state that it was a downgrade from an earlier recommendation or that a prior standard was explicitly reversed. (LLM, conf=0.82)
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- Authors
- Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., Altman, R. D., DiRenzo, D., Fontanarosa, J., Giradi, G., Ishimori, M., Misra, D., Shah, A. A., Shmagel, A. K., Thoma, L. M., Turgunbaev, M., Turner, A. S., & Reston, J.
- Affiliations
- University of Pennsylvania (US)
- Boston University (US)
- VA Maryland Health Care System (US)
- Arcadia University (US)
- McMaster University (CA)
- Rush University Medical Center (US)
- University of North Carolina at Chapel Hill (US)
- Ingalls Memorial Hospital (US)
- University of Michigan (US)
- Watchung New Jersey
- Tufts Medical Center (US)
- University of Toronto (CA)
- Fairfield Ohio
- University of Arizona (US)
- NYU Langone Health (US)
- University of Delaware (US)
- University of California Davis
- University of California, Los Angeles (US)
- Johns Hopkins University (US)
- ECRI Institute (US)
- Cedars-Sinai Medical Center (US)
- American College of Rheumatology (US)
- University of Minnesota (US)
- Corresponding author
- Kolasinski, Sharon L.
- ORCID
- Kolasinski, Sharon L.
- Neogi, Tuhina
- Hochberg, Marc C.
- Oatis, Carol
- Guyatt, Gordon
- Block, Joel
- Callahan, Leigh
- Felson, David
- Hawker, Gillian
- Kwoh, C. Kent
- Nelson, Amanda E.
- Samuels, Jonathan
- Scanzello, Carla
- White, Daniel
- Altman, Roy D.
- DiRenzo, Dana
- Fontanarosa, Joann
- Ishimori, Mariko
- Misra, Devyani
- Shmagel, Anna K.
- Thoma, Louise M.
- Turner, Amy S.
- Reston, James
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2020-01-06
- Volume
- 72
- Issue
- 2
- Pages
- 149-162
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC11488261
- OpenAlex
- W3000036091
- Cited by
- 2,516
- References
- 43
- Citations by year
- 2026: 234 · 2025: 360 · 2024: 419 · 2023: 448 · 2022: 451 · 2021: 414 · 2020: 181 · 2018: 1 · 2012: 1
- FWCI
- 281.42
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-05-11)
- Open access
- bronze
- doi.org
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Arthritis Foundation
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- osteoarthritis, hand osteoarthritis, hip osteoarthritis, knee osteoarthritis, osteoarthritis management, exercise therapy, weight loss, self-management program, Tai Chi, hand orthoses, thumb carpometacarpal joint, topical NSAIDs, chondroitin sulfate, acupuncture, radiofrequency ablation, cognitive behavioral therapy, kinesio taping, shared decision-making, pharmacotherapy
- MeSH terms
- Systematic Reviews as Topic, Analgesics, Exercise Therapy, Foundations, Humans, Rheumatology, United States, Osteoarthritis, Hip, Practice Guidelines as Topic, Disease Management, Osteoarthritis, Knee, Hand Joints
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