The American College of Rheumatology (ACR) recently updated its 2000 recommendations for hip and knee osteoarthritis (OA) and developed new recommendations for hand OA. The guidelines include nonpharmacologic therapies, such as exercise supervised by a physical therapist for knee and hip OA.  

The guidelines, which use clinical scenarios representing patients with symptomatic hand, hip, and knee OA are based on the "best available evidence of benefit and safety/tolerability" of both nonpharmacologic and pharmacologic interventions, in addition to the consensus judgment of clinical experts from a wide range of disciplines. They are published in the April 2012 issue of Arthritis Care & Research.  

According to the Technical Expert Panel, patients with symptomatic knee and hip OA should be enrolled in an individualized exercise program commensurate with their ability to perform these activities. The panel also calls for the use of thermal agents and manual therapy in combination with exercise supervised by a physical therapist.

Because there were few high-quality randomized controlled trials of interventions for hand OA published in the peer-reviewed literature, the panel made no strong recommendations for this indication. However, the panel recommends that all patients with hand OA be evaluated by a health professional, either their primary care provider or a physical therapist or occupational therapist for their ability to perform activities of daily living. Based on the evaluation, patients could receive assistive devices as necessary, instruction in joint protection techniques and in the use of thermal agents for relief of pain and stiffness. 

APTA members G. Kelley Fitzgerald, PT, PhD, and Carol A. Oatis, PT, PhD, served on the panel. 

Free, full text of the guidelines is available from ACR.