The Osteoarthritis Research Society International (OARSI), a multinational team set out to develop patient-focused, expert consensus-derived recommendations for individuals that are based on objective review of high-quality meta-analytic data has updated and refined knee, hip, and polyarticular osteoarthritis (OA) guidelines.
Their work, “OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis,” appears in the July 3, 2019 edition of Osteoarthritis and Cartilage.
Co-author Raveendhara R. Bannuru, M.D., director of the Center for Treatment Comparison and Integrative Analysis and an assistant professor of Medicine at the Tufts University School of Medicine, explained what OARSI is and why they decided to update these guidelines now.
He explained to OTW, “Osteoarthritis Research Society International (OARSI) is committed to providing clinical practitioners in with comprehensive, up-to-date data summaries about the efficacy and safety of new and established treatments for osteoarthritis as well as guidance on practice recommendations. As such, OARSI plans periodic updates of its publicly available clinical practice guideline reports.”
“The 2019 OARSI Guidelines were initiated with the intention of providing a five-year update of the evidence for knee and polyarticular osteoarthritis, as well as a ten-year update for hip osteoarthritis, for which the evidence body is significantly less dynamic. In this iteration of the OARSI Guidelines, we aimed to contemporize the guideline development process to produce patient-centric, evidence-based recommendations.”
“There was a general emphasis on prioritizing non-pharmacologic treatments, in the interest of promoting safer alternatives for long-term symptom management for patients with osteoarthritis.”
“For the first time, mind-body exercises (Tai Chi and Yoga) were recommended as Core Treatment options for individuals with knee OA, highlighting the importance of considering patients’ holistic wellbeing in an osteoarthritis treatment regimen.”
“Conversely, APAP (acetaminophen/paracetamol), which has long been regarded as a mainstay of OA treatment, was not recommended due to a lack of efficacy and unfavorable safety profile.”
“The Panel strongly recommended against the use of either oral or transdermal opioids in individuals with OA due to unfavorable benefit risk ratio. This guideline also provided more detailed recommendations pertaining to non-steroidal anti-inflammatory drugs (NSAIDs) tailored to individuals who present with comorbid gastrointestinal or cardiovascular comorbidities, which is common among the population of osteoarthritis patients.”
“The goal of crafting a treatment algorithm was to offer structured guidance to clinicians that would allow them to personalize treatment pathways based on an individual patient profile on a long-term and ongoing basis. It is important to note that in real-world clinical practice, many individuals may fall into more than one comorbidity subgroup during the course of their treatment pathway or may experience more than one type of comorbidity concurrently.”
“In summary, this guideline is meant to provide a framework of treatment pathways that will ultimately become highly personalized and specific to the patient-provider relationship.”
“We would like to emphasize that the recommendations presented within this guideline were an amalgamation of the available evidence and clinicians’ experiences and expertise.”
“We deliberately selected a diverse multidisciplinary Panel with the aim of producing guidelines that would be relevant to a number of clinical scenarios and representative in an international context. We also have reported the full ‘gradient’ of percentages in favor and against all of the treatments that were assessed to represent the nuance that exists in selecting appropriate treatments in real-world clinical practice. The intended result of this heightened detail is to encourage the practice of evidence-based medicine in OA care.”
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