Osteoarthritis: Rapid Evidence Review

Mark H. Ebell

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Apr 15, 2018 Issue

Osteoarthritis: Rapid Evidence Review

MARK H. EBELL, MD, MS, University of Georgia College of Public Health, Athens, Georgia

Am Fam Physician. 2018 Apr 15;97(8):523-526.

Patient information: A handout on this topic is available at https://familydoctor.org/condition/osteoarthritis.

Osteoarthritis (OA) should be suspected in patients with pain in the fingers, shoulders, hips, knees, or ankles, especially if they are older than 40 years. Patients older than 50 years who have joint pain, minimal morning stiffness, and functional impairment likely have OA. Radiography can confirm the diagnosis and may be helpful before surgical referral, but findings generally do not correlate well with symptoms. Exercise, physical therapy, knee taping, and tai chi are beneficial for knee OA. Medical therapy provides modest benefits in pain reduction and functional improvement; however, nonsteroidal anti-inflammatory drugs, tramadol, and other opioids have significant potential harms. Joint replacement may be considered for patients with moderate to severe pain and radiographically confirmed OA. Corticosteroid injections may be helpful in the short term. Vitamin D supplements, shoes specifically designed for persons with OA, antioxidant supplements, physical therapy for hip OA, ionized wrist bracelets, lateral wedge insoles for medial knee OA, and hyaluronic acid injections are not effective.

Osteoarthritis (OA) is a condition commonly encountered in primary care. This article provides a brief summary and review of the best available patient-oriented evidence for OA.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Radiography can confirm the diagnosis of OA and may be helpful before surgical referral, but findings tend not to correlate well with symptoms.	C	6, 7
Exercise, physical therapy, knee taping, and tai chi are beneficial for knee OA.	B	14–18
Ineffective treatments for OA include vitamin D and antioxidant supplements, shoes specifically designed for persons with OA, lateral wedge insoles for medial knee OA, physical therapy for hip OA, ionized wrist bracelets, and hyaluronic acid injections.	B	9–13, 19, 21, 50–52
Medical therapy for OA should begin with full-strength acetaminophen and topical therapy, then proceed to nonsteroidal anti-inflammatory drugs and selectively to tramadol and other opioids. Nonsteroidal anti-inflammatory drugs and opioids may reduce pain and improve function, but have significant potential harms.	A	26–36
Joint replacement should be considered for patients with moderate to severe pain and radiographically confirmed OA.	A	40, 41
Corticosteroid injections may be helpful in the short term, but evidence is mixed.	B	47–49

OA = osteoarthritis.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	References
Radiography can confirm the diagnosis of OA and may be helpful before surgical referral, but findings tend not to correlate well with symptoms.	C	6, 7
Exercise, physical therapy, knee taping, and tai chi are beneficial for knee OA.	B	14–18
Ineffective treatments for OA include vitamin D and antioxidant supplements, shoes specifically designed for persons with OA, lateral wedge insoles for medial knee OA, physical therapy for hip OA, ionized wrist bracelets, and hyaluronic acid injections.	B	9–13, 19, 21, 50–52
Medical therapy for OA should begin with full-strength acetaminophen and topical therapy, then proceed to nonsteroidal anti-inflammatory drugs and selectively to tramadol and other opioids. Nonsteroidal anti-inflammatory drugs and opioids may reduce pain and improve function, but have significant potential harms.	A	26–36
Joint replacement should be considered for patients with moderate to severe pain and radiographically confirmed OA.	A	40, 41
Corticosteroid injections may be helpful in the short term, but evidence is mixed.	B	47–49

OA = osteoarthritis.

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BEST PRACTICES IN ORTHOPEDICS

Recommendations from the Choosing Wisely Campaign

Recommendation	Sponsoring organization
Do not use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.	American Academy of Orthopaedic Surgeons
Do not use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.	American Academy of Orthopaedic Surgeons

Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant

The Author

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MARK H. EBELL, MD, MS, is a professor in the Department of Epidemiology at the University of Georgia College of Public Health, Athens....

Address correspondence to Mark H. Ebell, MD, MS, 125 Miller Hall, UGA Health Sciences Campus, Athens, GA 30602 Reprints are not available from the author.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc.

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