During an oral presentation, Dr. Hochberg presented key points that will be included in the 2000 update for the Medical Management of Osteoarthritis of the Hip and Knee Guidelines that is expected to be published in Arthritis and Rheumatism in the fall of 2000.

The main goals of the updated guidelines were to control pain, improve function and quality of life, and avoid therapeutic toxicity. Non-pharmacologic modalities, including patient education, self-management strategies, social support, weight loss, and physical and occupational therapy, are recommended. The recommendations include pharmacological therapy, as needed, with acetaminophen (4 gm/day) as the initial therapy for patients with mild to moderate pain. For patients with severe joint pain, alternative or additional therapy is recommended contingent upon an evaluation for upper gastrointestinal (UGI) risks, renal toxicities, comorbid conditions and concomitant medications. For patients not at risk for serious UGI events, NSAID with dual COX inhibitory activity (i.e., conventional NSAID or nonselective NSAID), topical therapy, and/or intra-articular therapy are recommended. For patients at risk for UGI, a COX-2 NSAID inhibitor or a nonselective NSAID administered with a GI protector are noted in the recommendations. Recommendations for intra-articular therapies, other analgesic therapy, nutrition, devices, DMOADs and indications for total joint replacement will also be included within the guidelines. Injectable corticosteriods and topical NSAIDs will also be addressed.

Editorial Comment: Prior guidelines for the management of OA were developed before the availability of the COX-2 inhibitors and before many of the nutraceuticals and complementary therapies that are currently in use by patients. The challenge of the new guidelines is to define a place in the therapeutic algorithm for the COX-2 inhibitors, and to determine the place, if any, for unproven alternative therapies.

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