Practice Guidelines

Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation


Am Fam Physician. 2021 Jan 15;103(2):120-121.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Weight loss, exercise, tai chi, and patient-directed activity programs can improve pain and function in knee and hip OA.

• In knee and hip OA, intra-articular corticosteroid injections and oral and topical NSAIDs improve pain and function only over the short term.

• Transcutaneous electrical nerve stimulation, immunomodulators, glucosamine, and biologic injection therapies should be avoided in OA.

• Cognitive behavior therapy and balance training appear to improve pain in OA; acupuncture and thermal interventions slightly improve pain and function.

From the AFP Editors

Affecting more than 300 million people worldwide, osteoarthritis (OA) is common and difficult to manage. Although OA can involve any joint, the knee, hip, and hand are most commonly affected. The 2019 American College of Rheumatology/Arthritis Foundation guidelines reviewed the effectiveness of pharmacologic and nonpharmacologic treatments for OA in the knee, hip, and hand.

Recommended Treatments


The guideline recommends exercise, tai chi, and self-efficacy or self-management programs as first-line treatments. Exercise and tai chi slightly improve pain and function in knee and hip OA. No particular exercise is superior, although most studies used aerobic exercise. The benefit from tai chi lasts for at least 24 weeks, whereas exercise is beneficial for up to one year. Pain in OA is related to weight, and even a 5% weight loss provides notable improvement in knee and hip pain. Patient-directed activities, such as using activity trackers, online modules, cognitive behavior therapy, and goal setting consistently demonstrate small improvements in function and pain.

A few treatments are effective for OA in specific joints. For knee OA, tibiofemoral knee braces reduce pain and improve walking speed. Hand orthoses appear to improve pain and function for OA in the first carpometacarpal joint.


Although recommendations include medical treatment, effective

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



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