Non-surgical management of hip and knee osteoarthritis; comparison of ACR/AF and OARSI 2019 and VA/DoD 2020 guidelines

Osteoarthritis (OA) is the most common form of arthritis and is associated with significant morbidity and mortality. There are several available recently updated guidelines for the management of hip and knee OA. Herein, we describe the similarities and differences among the 2019 American College of Rheumatology/Arthritis Foundation (ACR/AF), the 2019 Osteoarthritis Research Society International (OARSI), and the 2020 Veterans Affairs and Department of Defense (VA/DoD) treatment guidelines. In all the three guidelines, patient education, weight loss encouragement for overweight patients, exercise, and self-efficacy and self-management programs were considered core treatments for hip and knee OA. Topical NSAIDs are strongly recommended for knee OA, oral NSAIDs and intraarticular steroid injections are also recommended among all three guidelines. The ACR/AF and VA/DoD recommend the use of paracetamol and topical capsaicin in contrast to the OARSI guidelines. Intra-articular hyaluronic acid is not recommended by the ACR/AF in contrast to the OARSI and VA/DoD. Another difference is the use of tramadol in patients with persistent knee or hip OA pain, which is recommended by ACR/AF as opposed to VA/DoD and OARSI who recommend against the use of opioid analgesics without exceptions. All three guidelines are mostly consistent in their recommendations.