Overview of Updated ACR Guidelines
The American College of Rheumatology (ACR) has revised its clinical guidance for the management of osteoarthritis (OA), updating its previous 2019 recommendations. The updated guidelines prioritize wellness interventions, establishing self-efficacy and self-management as the foundational elements of OA care.
Sharon L. Kolasinski, MD, principal investigator at the Perelman School of Medicine, University of Pennsylvania, explained the rationale behind the updates:
โThese updated recommendations recognize that there is no single treatment pathway that fits every person living with osteoarthritis. Our strongest recommendations continue to center on helping people build confidence in managing their condition, remaining physically active and pursuing weight loss when appropriate. At the same time, the new evidence gives clinicians and patients additional options to discuss, in carefully selected situationsโ.
Therapeutic Recommendations
The guidelines outline both strong and conditional recommendations for pharmacologic and nonpharmacologic therapies.
Table 1. Strong and Conditional Recommendations for OA Management
| Recommendation Type | Intervention | Applicable OA Types & Populations |
| Strong (For) | Exercise | Knee and hip OA |
| Strong (For) | Weight loss | Knee and hip OA in patients meeting overweight or obesity criteria |
| Strong (For) | Topical and oral NSAIDs | General OA, when clinically appropriate |
| Strong (For) | Intraarticular glucocorticoid injections | Knee and hip OA; must be guided by ultrasound |
| Conditional (For) | GLP-1 receptor agonists for weight loss | Knee OA in patients with obesity |
| Conditional (For) | Tai chi, yoga, cognitive behavioral therapy, therapeutic heating/cooling | Knee, hip, hand, or other forms of OA, as part of a comprehensive wellness strategy |
| Conditional (For) | Intraarticular injections | Hand OA |
Table 2. Strong Recommendations Against Specific Interventions
| Interventions Strongly Recommended Against | Applicable OA Types |
| Platelet-rich plasma and stem cell injections | Knee and hip OA |
| Hydroxychloroquine and bisphosphonates | Knee, hip, and hand OA |
| Glucosamine, chondroitin, or combination preparations | Knee, hip, and hand OA |
| TNF-alpha inhibitors | Knee, hip, and hand OA |
| Interleukin-1 inhibitors | Hand OA |
Good Practice Statements
The authors established three core good practice statements to guide clinical care:
- Patient Education: Clinicians should educate patients to actively enhance their self-efficacy.
- Rehabilitation Referrals: Physical or occupational therapy should be utilized when exercise limits a patientโs function or exacerbates their pain.
- Mobility Support: Canes or alternative mobility aids should be provided for patients whose hip or knee OA restricts walking.
Multidisciplinary and Individualized Care
An ACR press release emphasized that treatment paradigms must be individualized and multimodal:
โTreatment decisions should account for OA severity, pain and functional limitations, other health conditions, prior surgery, medication risks, transportation and financial barriers, insurance coverage, and the patientโs ability to participate in care. Many people may benefit from a multidisciplinary approach involving primary care clinicians, rheumatologists, physical therapists, occupational therapists, orthopedic surgeons, and other members of the care teamโ.
