Not yet independently audited
This page was written from verified sources but has not yet passed the independent citation audit. Treat its claims as provisional.
Osteoarthritis guideline registry¶
Last checked: 2026-10-29 (official ACR, VA/DoD, EULAR, NICE, AAOS and OARSI sources; dated PubMed searches)
Scope and status rules¶
This registry catalogs documents; synthesis is in wiki/guidelines.md. “Current” means no explicit replacement was identified on the issuing body’s site or in the retrieved record on the check date; it does not guarantee that every recommendation reflects the newest trial. PubMed-indexed documents were fetched live by PMID. Official web documents were opened or returned from the issuing body's site on the access date.
Master table¶
| Body | Year | Region | Scope | Citation | Status |
|---|---|---|---|---|---|
| VA/DoD | 2026, version 3.0 | USA, VA/DoD systems | Nonsurgical hip/knee OA | Official guideline portal, provider summary, accessed 2026-10-22 | current; replaces 2020; June release predates sweep window; evidence through July 2025 |
| EULAR | 2025 update, published 2026 | International | Physical activity in inflammatory arthritis and OA | Rausch Osthoff et al., PMID 42036268; official EULAR listing, accessed 2026-10-22 | current update of 2018 physical-activity recommendations; distinct from 2023 hip/knee core-management guideline; April online release predates sweep window |
| NICE | 2022 | England / UK relevance | Diagnosis and management, adults | NG226 (official page, accessed 2026-08-30) | current; supersedes CG177 (2014) |
| ACR | 2026 update (summary posted 2026-09-14; Board-approved 2026-09-08) | USA | Hand, hip and knee, behavioural/physical and pharmacologic | ACR 2026 summary PDF via official ACR page, accessed 2026-10-15; no PubMed record on 2026-10-15; full manuscript to be submitted to Arthritis Rheumatol and Arthritis Care Res | current as summary; updates ACR/AF 2019 — full text and evidence profiles pending |
| ACR / Arthritis Foundation | 2019 (published 2020) | USA | Hand, hip and knee, comprehensive nonsurgical | Kolasinski et al., PMID 31908149 | updated by → ACR 2026 summary; remains the only full-text ACR document until the 2026 manuscript is published |
| OARSI | 2019 | International | Knee, hip and polyarticular nonsurgical care | Bannuru et al., PMID 31278997; official OARSI page, accessed 2026-08-30 | current OARSI comprehensive nonsurgical document |
| AAOS | 2023 (summary 2024) | USA | Hip OA management, adults (8 recommendations, 9 options) | Hannon et al., PMID 38781351; erratum PMID 42825586 (2026-10-15; Crossref type correction) |
current; first registered 2026-10-15 — content of the correction not retrieved |
| AAOS | 2021 (summary 2022) | USA | Knee OA, nonarthroplasty | Brophy et al., PMID 35383651; erratum PMID 42825585 (2026-10-15; Crossref type correction); official AAOS page, accessed 2026-10-29 |
current; supersedes 2013 second edition. The quality-program-library URL used in the 2026-10-29 official-source probe returned HTTP 404; this osteoarthritis-of-the-knee URL returned 200 |
| AAOS | 2022 | USA | Surgical management of knee OA | official AAOS CPG catalog, accessed 2026-08-30; prior evidence-based document PMID 27355287 | current catalog entry; verify full-manuscript review date |
| EULAR | 2023 update (published 2024) | Europe | Non-pharmacological core management, hip and knee | Moseng et al., PMID 38212040 | current; supersedes Fernandes 2013 |
| EULAR | 2013 | Europe | Non-pharmacological core management, hip and knee | Fernandes et al., PMID 23595142 | superseded by → EULAR 2023 update (PMID 38212040) |
| EULAR | 2018 (published 2019) | Europe | Hand OA management | Kloppenburg et al., PMID 30154087 | current; supersedes EULAR 2007 |
| EULAR | 2021 | Europe | Intra-articular therapies across arthropathies | Uson et al., PMID 34035002 | current adjunct, not an OA-comprehensive guideline |
| EUROVISCO (expert group, 7 European countries) | 2025 (print 2026) | Europe | Delphi good-practice recommendations for knee hyaluronan viscosupplementation, 30 clinical scenarios (consensus on 18) | Monfort et al., PMID 40156368 | expert consensus, not a society CPG; obesity and advanced radiographic grade named as main predictors of poor response |
| EULAR | 2017 | Europe | Imaging in peripheral-joint OA | Sakellariou et al., PMID 28389554 | current adjunct |
| RACGP | 2018 | Australia | Knee and hip OA before joint replacement | second-edition PDF, accessed 2026-08-30 | current official page found; supersedes 2009 edition |
| ESCEO | 2019 | Europe / international expert algorithm | Stepwise knee OA pharmacologic algorithm | Bruyère et al., PMID 31126594; Central-European endorsement, PMID 31129712 | current version found; GRADE-informed consensus algorithm rather than national CPG |
| French Society of Rheumatology + Physical and Rehabilitation Medicine | 2024 | France | Nonpharmacologic knee OA | Pers et al., PMID 39490291 | current |
| French societies | 2026 | France | Hand OA | Courties et al., PMID 41183591 | current as indexed in the 2026-08-30 audit search |
| Turkish League Against Rheumatism | 2020 | Türkiye | Hand OA | Ayhan et al., PMID 33458653 | current document found |
| Italian Society for Rheumatology | 2013 | Italy | Hand OA | Manara et al., PMID 24192562 | current status uncertain; watch for replacement |
| Royal Dutch Society for Physical Therapy | 2020 | Netherlands | Physical therapy for hip/knee OA | KNGF guideline paper, PMID 32643252 | current paper found; supersedes earlier physiotherapy guidance |
| Mexican national guideline implementation target | 2008 | Mexico | Hip/knee OA primary care | Implementation study identifying the CPG, PMID 24909101 | underlying guideline likely superseded; verify official archive |
| ACR | 2012 | USA | Hand, hip and knee nonsurgical treatment | Hochberg et al., PMID 22563589 | superseded by → ACR/AF 2019 |
| OARSI | 2014 | International | Knee OA nonsurgical care | McAlindon et al., PMID 24462672 | superseded by → OARSI 2019 |
| AAOS | 2013 | USA | Knee OA nonarthroplasty | Jevsevar, PMID 23996988 | superseded by → AAOS 2021 third edition |
| EULAR | 2007 | Europe | Hand OA management | Zhang et al., PMID 17046965 | superseded by → EULAR 2018 update |
| EULAR | 2009 | Europe | Hand OA diagnosis | Zhang et al., PMID 18250111 | diagnostic document; not replaced by the management update |
| Dutch multidisciplinary guideline | 2007/2008 | Netherlands | Hip/knee OA diagnosis and treatment | PMID 19818192 | superseded/archival; confirm chain with issuing body |
Current guideline profiles¶
NICE NG226 (2022)¶
- Case definition: clinical diagnosis without routine imaging at age ≥45 years with activity-related pain and no morning stiffness or stiffness ≤30 minutes; image atypical presentations (official NG226 page, accessed 2026-08-30).
- Core care: tailored therapeutic exercise; weight management when relevant; information and support. NICE states that 10% weight loss is likely to confer more benefit than 5%.
- Medicines: offer topical NSAID for knee OA; consider oral NSAID with toxicity assessment and gastroprotection. Do not routinely offer paracetamol or weak opioids; do not offer strong opioids or glucosamine.
- Injections: do not offer intra-articular hyaluronan; corticosteroid may be considered with an explicit 2–10-week relief expectation.
- Surgery: refer based on quality-of-life impact and failure/unsuitability of nonsurgical care; do not exclude solely because of age, sex/gender, smoking, comorbidity or BMI.
- Supersession: explicitly updates and replaces CG177 (2014) on the official overview page.
ACR/Arthritis Foundation (2019)¶
- Systematic review plus GRADE and a multidisciplinary panel including patients (Kolasinski 2020, PMID 31908149).
- Strong recommendations include exercise, weight loss for overweight/obese knee or hip OA, self-management, tai chi, cane, selected orthoses/bracing, topical NSAID for knee, oral NSAIDs and knee intra-articular glucocorticoid.
- Conditional options include CBT, yoga, acupuncture, radiofrequency ablation, acetaminophen, duloxetine and tramadol.
- Conditional recommendation against hyaluronic acid at knee and strong against at hip is a central disagreement with more permissive algorithms.
OARSI (2019)¶
- Patient-focused recommendations stratified by knee-only, hip, or polyarticular disease and comorbidity (Bannuru 2019, PMID 31278997).
- Education, structured land exercise and dietary weight management are core treatments for knee OA; topical NSAIDs are strongly recommended for knee OA.
- Oral NSAID selection is stratified by gastrointestinal and cardiovascular comorbidity and frailty.
- The OARSI official page identifies this as the 2019 update to earlier guidance (accessed 2026-08-30).
AAOS knee nonarthroplasty, third edition (2021)¶
- Applies to adults with diagnosed knee OA and covers nonpharmacologic, pharmacologic and procedures less invasive than replacement (official AAOS page, accessed 2026-08-30).
- The PubMed summary is Brophy et al. 2022 (PMID 35383651).
- The official page states that the third edition replaces the 2013 second edition.
- Orthopedic scope and evidence thresholds differ from rheumatology panels, particularly around injections and arthroscopy.
EULAR hand OA (2018 update)¶
- Prioritizes education, assistive devices, exercises and orthoses with individualized pharmacologic care (Kloppenburg 2019, PMID 30154087).
- Topical treatments are favored over systemic treatments for safety.
- EULAR 2007 management guidance (PMID 17046965) is the explicit predecessor.
- The evidence review informing the update is separately indexed (Kroon 2018, PMID 30402266).
RACGP knee and hip OA (2018)¶
- Primary-care guideline covering adults with symptomatic hip/knee OA until joint-replacement referral.
- The official PDF states that it is the second edition and updates 2009 nonsurgical guidance (accessed 2026-08-30).
- Multidisciplinary development included consumer representatives.
- Its national implementation context and intervention access differ from US and UK documents.
EULAR hip/knee non-pharmacological core management (2023 update)¶
- Two overarching principles and eight recommendations covering an individualised multicomponent plan; information/education/self-management; exercise dose and delivery; healthy weight; and related core non-drug care (Moseng 2024, PMID 38212040).
- Explicit successor to Fernandes 2013 (PMID 23595142), whose 11 recommendations had panel agreement 8.0–9.1/10.
- Does not replace OARSI/ACR/NICE pharmacologic recommendations.
ESCEO 2019 knee algorithm¶
- GRADE-informed stepwise algorithm with 15 voted recommendations, mixing strong and weak ratings (Bruyère 2019, PMID 31126594).
- More permissive of background SYSADOA/paracetamol than NICE NG226, which does not routinely offer paracetamol and does not offer glucosamine.
- Algorithm, not a national CPG.
French nonpharmacologic knee OA (2024)¶
- Joint recommendations of rheumatology and physical/rehabilitation societies (Pers 2024, PMID 39490291).
- Useful as a contemporary focused complement to broad pharmacologic guidelines.
- Its narrower scope should not be misread as silence on drug or surgical care.
Supersession chains¶
| Topic | Chain |
|---|---|
| UK comprehensive OA | NICE CG177 (2014) → NICE NG226 (2022) |
| ACR hand/hip/knee | ACR 2012 (PMID 22563589) → ACR/AF 2019 (PMID 31908149) → ACR 2026 update (summary only, 2026-09-14) |
| OARSI knee/nonsurgical | OARSI 2008/2010 series → OARSI 2014 (PMID 24462672) → OARSI 2019 (PMID 31278997) |
| AAOS knee nonarthroplasty | AAOS 2013 second edition (PMID 23996988) → AAOS 2021 third edition (PMID 35383651) |
| EULAR hand management | EULAR 2007 (PMID 17046965) → EULAR 2018 update (PMID 30154087) |
| EULAR hip/knee nonpharm | Fernandes 2013 (PMID 23595142) → Moseng 2023/2024 update (PMID 38212040) |
| RACGP hip/knee | RACGP 2009 → RACGP second edition 2018 |
Disagreements and gaps¶
| Issue | More favorable / permissive | More restrictive | Why the conflict persists |
|---|---|---|---|
| Intra-articular hyaluronan | Some expert algorithms and practice pathways allow selected use | NICE says do not offer; ACR/AF recommends against routine knee use | Small-study effects, product heterogeneity, contextual effects, cost and different minimum-important-benefit thresholds |
| PRP | Orthobiologic consensus statements allow selected knee-OA use | ACR/AF recommends against; NICE 2022 does not recommend routine use | Product standardization, placebo-controlled evidence and evidence cut-off differ |
| Acupuncture | ACR/AF 2019 conditional recommendation; ACR 2026 summary conditional for (moderate certainty knee/hip) | NICE says do not offer | Small effects, sham choice, cost-effectiveness and panel weighting |
| Acetaminophen | ACR/AF conditional option | NICE: not routine, only infrequent short-term when alternatives unsuitable | Small average benefit and differing concern about NSAID contraindications |
| Knee bracing | ACR/AF 2019 strongly recommends tibiofemoral bracing in the matching phenotype; the ACR 2026 summary lists tibiofemoral and patellofemoral braces as conditional for (certainty very low to moderate by type) | NICE discourages routine devices unless instability/abnormal load and exercise inadequate | Phenotype selection, adherence and service-cost assumptions |
| GLP-1 RA for obesity in knee OA | ACR 2026 summary: conditional for, with diet and exercise (moderate certainty; new) | NICE NG226 names no drug for weight loss | NG226 (2022) predates STEP 9 (2024) and TRIUMPH-1 (2026); structural benefit unshown |
| Methotrexate | ACR 2026 summary: conditional for in erosive hand OA (direction changed since 2019) | ACR 2026 summary: conditional against in knee/hip | Knee trials conflict (PROMOTE positive, synovitis-enriched trial null); the summary does not show the evidence behind either position |
| Arthroplasty eligibility | NICE rejects exclusion solely by BMI/age/smoking | Local institutional thresholds often persist | Surgical risk prediction, resource allocation and equity are not resolved by efficacy trials |
| Imaging | NICE favors clinical diagnosis without routine imaging | Surgical and research pathways use radiographs for anatomy and staging | Diagnostic confirmation, differential diagnosis, trial classification and operative planning are different use cases |
Watch list¶
- Recheck NICE NG226 when its surveillance page reports a review decision.
- Recheck OARSI for a successor to the 2019 nonsurgical guideline.
- Check whether AAOS posts a fourth knee nonarthroplasty edition or revises PRP/hyaluronate language.
- Seek current official replacements for Italian 2013, Turkish 2020, Dutch 2020 and Mexican 2008 documents.
- Track new EULAR hand OA and imaging updates.
- Recheck EULAR 2023 nonpharm document for a pharmacologic companion.
- Track guidance incorporating semaglutide/large pharmacologic weight loss for obesity-associated knee OA. NICE NG226 already states 10% loss is likely better than 5%; it does not yet name GLP-1 agonists. 2026-10-15: the ACR 2026 summary now conditionally recommends GLP-1 RA in knee OA with obesity.
- Watch for the ACR 2026 full manuscript (Arthritis Rheumatol / Arthritis Care Res) and its PMID; replace the summary-PDF citation when it appears and check which 2019 recommendations changed in strength.
- Obtain the text of the 2026-10-15 AAOS knee and hip corrections (PMIDs 42825585, 42825586) and check whether any recommendation strength changed.
- NICE NG226 page re-opened 2026-10-15: still "Published 19 October 2022 … Last reviewed 19 October 2022"; no update or surveillance decision shown. OARSI's former guideline URL returned HTTP 404 on 2026-10-15; no OARSI successor to 2019 found in PubMed (2026-08-28 to 2026-10-15).
- Track formal product-standard requirements for PRP and cell-based injections.
- Super 2026 unloader-brace Delphi (PMID 42809374) is expert consensus, not a society CPG; do not promote it into the current-guideline table unless a named society adopts it.
Verification caveats¶
- PubMed verifies the indexed publication, not the issuing body's current-status designation.
- Official sites can update without a new PMID; all URL statuses are point-in-time observations on 2026-08-30, except entries marked 2026-10-15.
- Several national documents are language- or archive-limited; these are labeled uncertain rather than silently treated as current.
2026-10-22 verification and disagreements¶
- ACR still posts the 2026 summary; the windowed PubMed manuscript search returned zero records. The pharmacology page now reflects the retrieved summary's opioid, duloxetine and supplement positions.
- OARSI's formerly unavailable URL now loads and lists its 2019 document. NICE NG226 still displays “Last reviewed: 19 October 2022”; AAOS still lists the 2021 knee third edition. OARSI, NICE, AAOS, accessed 2026-10-22.
- The VA/DoD 2026 Table 1 takes no position for or against knee viscosupplementation, knee/hip PRP, or glucosamine/chondroitin because evidence is insufficient. ACR 2026 recommends against these treatments. Preserve both judgments; a neutral evidence statement is not a positive recommendation. See the guidelines synthesis.
- AAOS knee/hip erratum metadata were re-fetched, including Crossref correction relationships; the text remains unavailable. Their presence does not establish a change in recommendation strength. Keep the earlier correction watch items open.
2026-10-29 verification¶
- ACR still posts the 4-page 2026 summary (posted 2026-09-14); PubMed manuscript query for 2026 ACR OA recommendations returned 0. ACR OA guideline page and summary PDF, accessed 2026-10-29.
- NICE NG226 still shows last reviewed 19 October 2022. OARSI still lists the 2019 nonsurgical document. VA/DoD 2026 portal resolved. EULAR listing still shows the 2025 physical-activity update and the 2023 hip/knee core-management update.
- AAOS
.../quality-program-library/osteoarthritis-of-the-knee-non-arthroplasty/returned HTTP 404;https://www.aaos.org/quality/quality-programs/osteoarthritis-of-the-knee/returned 200. Erratum text for PMIDs 42825585 and 42825586 remains unavailable. - Added expert-consensus watch item, not a society CPG: Super 2026 unloader-brace modified Delphi (29 experts; 42 round-3 statements; PMID 42809374). Brace disagreement in the table above is unchanged; this document does not adjudicate ACR vs NICE.