title: A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative.
abstract: OBJECTIVE
  Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers.
  
  
  METHODS
  A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data.
  
  
  RESULTS
  Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin.
  
  
  CONCLUSIONS
  The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs.
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC. Electronic address: aenelson@med.unc.edu.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Nelson
authors.affiliation: Department of Medicine, Duke University Medical Center & Health Services Research & Development, VA Medical Center, Durham, NC.
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Golightly
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Goode
authors.affiliation: Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Department of Orthopaedics, University of North Carolina, Chapel Hill, NC.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Jordan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement; D001182:Arthroscopy; D002183:Canes; D003646:Debridement; D005081:Exercise Therapy; D006801:Humans; D007270:Injections, Intra-Articular; D010003:Osteoarthritis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012648:Self Care; D014481:United States; D014853:Walkers; D061217:Weight Reduction Programs
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Guidelines; Management; Osteoarthritis; Systematic review