Key Questions for HIP OA

Key Question 1

• What is the clinical effectiveness of the following pharmacologic and non-pharmacologic therapies in patients with primary or secondary OA of the hip, compared with placebo/sham controls or compared with other active interventions?

Pharmacologic treatment

Duloxetine

Intraarticular corticosteroids

Intraarticular hyaluronic acid

Intraarticular platelet-rich plasma/ ultrasound-guided intraarticular injections of platelet-rich plasma

Intramuscular corticosteroid injection

Glucosamine and chondroitin sulfate

NSAIDs (ibuprofen, dexibuprofen, fenbufen, diclofenac, naproxen, paracetamol)

COX-2-selctive inhibitors (celecoxib, meloxicam)

Tramadol

Acetaminophen

Tapentadol

Opioid therapy for hip OA

Tanezumab

Alendronate

Alternative treatments, including:

Complex Ayurvedic treatment Avocado-soybean unsaponifiable -Expanscience (ASU-E) effect on structure modification in hip OA

Low molecular weight hydrolyzed chicken sternal cartilage extract, BioCell Collagen

UP446, a novel dual pathway inhibitor anti-inflammatory agent of botanical origin

Non-pharmacologic treatment

Thermal baths with a sulfid mineral water

Exercise therapy for hip OA

Physical therapy

Neuromuscular exercise in patients with severe OA of the hip

Gluteus medius muscle activity for hip OA

High-velocity resistance training/low -velocity resistance training

Tailored activity pacing for hip OA

Manual therapy for hip OA

Basic Body Awareness Therapy (BBAT) for patients with hip OA

Cognitive behavioral therapy for chronic pain

Internet-Based Pain Coping Skills Training for patients with hip OA

Self-management program

Pulsed radiofrequency for hip OA

Acupuncture for hip OA

Kneipp hydrotherapy for hip OA

• How do the outcomes of each intervention differ by the following population and study characteristics: sex, disease subtype (lateral, patellofemoral), severity (stage/baseline pain and functional status), weight status (body mass index), baseline fitness (activity level), comorbidities, prior or concurrent treatments (including self-initiated therapies), and treatment duration or intensity?

Key Question 2

• What harms are associated with each of the above interventions in patients with primary or secondary OA of the hip?
• How do the harms associated with each of the above interventions differ by the following population or study characteristics: sex, disease subtype (lateral tibiofemoral, patellofemoral), severity (stage/baseline pain and functional status), weight status (body mass index), baseline fitness (activity level), comorbidities, prior or concurrent treatments (including self-initiated therapies), and treatment duration or intensity?

Key Questions for HAND OA

Key Question 1

• What is the clinical effectiveness of the following pharmacologic and non-pharmacologic therapies in patients with primary or secondary OA of the hand, compared with placebo/sham controls or compared with other active interventions?

Pharmacological treatment

Duloxetine

Topical therapy

DMARDs (Plaquenil, etc.)

Intraarticular corticosteroids

Intraarticular hyaluronic acid

Intraarticular platelet-rich plasma/ ultrasound-guided intraarticular injections of platelet-rich plasma

Doxycycline treatment for erosive osteoarthritis of the hand

Glucosamine and chondroitin sulfate

NSAIDs (ibuprofen, dexibuprofen, fenbufen, diclofenac, naproxen, paracetamol)

Topical NSAIDs (felbinac, ketoprofen, diclofenac) for hand OA

COX-2-selctive inhibitors (celecoxib, meloxicam)

Diacerein in hand OA

Arnica (topical) for hand OA

Hydroxycoumarin content of Sphaeralcea angustifolia for hand OA

Tramadol for hip and hand OA

Acetaminophen

Capsaicin

TNF- inhibitor infliximab for hand OA in patients with RA

Adhesive patches containing Chinese herbal mixtures FNZG and SJG

Marhame-Mafasel compress (herbal)

Stinging nettle leaf (topical)

Non-pharmacological treatment

Occupational therapy (strengthening, splinting, etc.)

Mud-bath treatment on hand osteoarthritis

Paraffin bath treatment

Thermal baths with a sulfate-calcium-magnesium-fluorides mineral water

Low level laser therapy (LLLT) for hand OA

• How do the outcomes of each of the above interventions differ by the following population and study characteristics: sex, disease subtype (lateral, patellofemoral), severity (stage/baseline pain and functional status), weight status (body mass index), baseline fitness (activity level), comorbidities, prior or concurrent treatments (including self-initiated therapies), and treatment duration or intensity?

Key Question 2

• What harms are associated with each of the above interventions in patients with primary or secondary OA of the hand?
• How do the harms associated with each of the above interventions differ by the following population or study characteristics: sex, disease subtype (lateral tibiofemoral, patellofemoral), severity (stage/baseline pain and functional status), weight status (body mass index), baseline fitness (activity level), comorbidities, prior or concurrent treatments (including self-initiated therapies), and treatment duration or intensity?

Outcomes of Interest for all Key Questions above:

Reduced pain

Improved function/mobility

Quality of life

Functional status measures, including Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores

Generally focus on clinical outcomes as opposed to radiologic or other intermediate outcomes.

The ACR last published OA guidelines for hip, knee and hand in 2012, so they need to be updated. This update will be done in collaboration with the ACP, producing the first ACR-ACP joint OA guideline, which is significant because many OA patients are treated by primary care or internists, not specialists.

If AHRQ prioritizes its OA-related literature review efforts for knee and adds hip and hand and possibly also shoulder, so that up to date lit reviews can be available by the end of 2017, and the data from the abstraction phase of the literature reviews can be shared electronically so it can be used to populate GRADE evidence profiles, the ACR and ACP will be able to use AHRQ's literature reviews as the basis of its new joint OA guideline.

This type of collaboration between AHRQ, ACR and ACP would be very valuable to providers who treat OA, and to OA patients.

It will serve as the basis of new, joint clinical practice guidelines for OA that will be developed by the American College of Rheumatology and the American College of Physicians.

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American College of Rheumatology and American College of Physicians

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