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Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation

  • Review Article
  • Published:

From Nature Reviews Rheumatology

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Abstract

Osteoarthritis (OA) is a complex musculoskeletal disease and a leading cause of pain and disability worldwide. Hip and knee OA alone are major contributors to global disability, having notable effects on individual well-being, increasing the reliance of individuals on health-care services and contributing to a rise in the socioeconomic burden. Consistent, coordinated and tailored approaches are important for providing appropriate care to all people with OA, but despite the scale of the challenge many individuals are still not offered the safe, best-evidence treatments recommended for OA care. This Review discusses the core priority treatments for OA, including exercise and physical activity, weight-loss, education and support for self-management. Additional physical or psychological evidence-based adjunctive therapies and combined therapies that can be used to tailor individual programmes are also discussed. These options include cognitive behavioural therapy, heat therapy, walking aids and splints, manual therapies and transcutaneous electrical nerve stimulation. International examples of OA treatment options, models of care and resources available are also given. Many challenges still need to be addressed to advance the uptake of these conditions, including further discussion around the risks and costs involved with all treatments.

Key points

  • Osteoarthritis (OA) is a complex and multifaceted musculoskeletal condition and a leading cause of pain and disability internationally.

  • Surgery and medications are not first-line treatments for OA, but rather a suite of non-surgical, best-evidence interventions are the main interventions recommended by international bodies overseeing the treatment of this condition.

  • Non-surgical core treatments for OA include exercise, weight-loss and education and support for self-management; these treatments can be supported by other physical or psychological adjunctive therapies.

  • All therapies must be discussed with the individual and target the needs of the individual, including consideration of complex comorbid conditions such as diabetes, hypertension and cardiovascular disease.

  • Coordinated programmes of OA care are urgently needed to ensure that consistent, accurate multidisciplinary care is provided to all patients to reduce the international burden on health-care systems.

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Fig. 1: Core and adjunctive treatment options for OA.
Fig. 2: Effect sizes for a selection of recommended first-line and adjunctive treatments for knee OA.

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Acknowledgements

J.L.B., D.J.H., V.D., L.A.D. and J.P.E. have secondary affiliations with the Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia. K.D.A. has a secondary affiliation with the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, VA Healthcare System, USA. D.J.H. is supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship. K.S.D. is an NIHR Senior Investigator.

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Authors and Affiliations

  1. Institute of Bone and Joint Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia

    Jocelyn L. Bowden, David J. Hunter, Leticia A. Deveza, Vicky Duong & Jillian P. Eyles

  2. School of Primary Community and Social Care, Keele University, Keele, UK

    Krysia S. Dziedzic

  3. Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA

    Kelli D. Allen

  4. Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong

    Ping-Keung Chan

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D.J.H., J.L.B., L.A.D., V.D. and J.P.E. researched data for the article. D.J.H., J.L.B., L.A.D., K.S.D., K.D.A., P.-K.C. and J.P.E. wrote the article. D.J.H., J.L.B., V.D., K.S.D., K.D.A., P.-K.C. and J.P.E. provided a substantial contribution to discussions of content. All authors reviewed or edited the article before submission.

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Correspondence to Jocelyn L. Bowden or David J. Hunter.

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Competing interests

D.J.H. provides consulting advice to Pfizer, Lilly, Merck Serono and TLC bio. J.L.B., V.D., L.A.D., K.S.D., K.D.A., P.-K.C. and J.P.E. declare no competing interests.

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Nature Reviews Rheumatology thanks G. A. Hawker, E. M. Roos and T. P. M. Vliet Vlieland for their contribution to the peer review of this work.

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Bowden, J.L., Hunter, D.J., Deveza, L.A. et al. Core and adjunctive interventions for osteoarthritis: efficacy and models for implementation. Nat Rev Rheumatol 16, 434–447 (2020). https://doi.org/10.1038/s41584-020-0447-8

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