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Kolasinski SL, et al. 2019 ACR/Arthritis Foundation Guideline for Management of Hand, Hip, and Knee OA. Arthritis Care Res. 2020;72:149–162. PMID 31908149

One-paragraph summary

The ACR/AF panel used systematic reviews, GRADE and a multidisciplinary voting panel including patients. Strong recommendations included exercise; weight loss for overweight/obese hip or knee OA; self-management; tai chi; cane use; first-CMC hand orthoses; tibiofemoral bracing; topical NSAIDs for knee OA; oral NSAIDs; and intra-articular glucocorticoid for knee OA. Conditional recommendations included CBT, yoga, balance exercise, acupuncture, radiofrequency ablation, acetaminophen, duloxetine and tramadol.

Key findings

  • Recommendation strength combined evidence certainty, benefit–harm balance and panel values; it was not an effect-size ranking.
  • Joint specificity matters: a treatment recommended at the knee was not automatically recommended for the hip or hand.
  • Shared decision-making and comorbidity were explicit implementation requirements.
  • The authors stated that recommendations should not be used to deny access.

Limitations

  • Literature cut-off predates several major injection, metabolic-weight-loss and DMOAD studies.
  • Conditional recommendations are vulnerable to being read as equivalent despite different evidence and risk profiles.
  • US health-system assumptions limit direct transfer of access and cost judgments.

Why it matters

This guideline remains a central reference because it integrates physical, behavioral, mind–body and pharmacologic options using one transparent framework and includes patient voters.

Cited by wiki pages

  • guidelines
  • exercise, weight and self-management
  • pharmacologic treatment