EULAR

• One must combine non-pharmacological and pharmacological treatments.
• Treatment should consider the type of arthritis, the presence of inflammation, structural changes, pain, disability, comorbidity and co-medication.
• Patient education and an exercise programme are recommended.
• Thermotherapy and ultrasound are beneficial.
• Paracetamol is the first-line analgesic to continue in the long term if it is effective.
• Oral NSAIDs are indicated in case of failure of paracetamol. Their effect should be reassessed on a regular basis. In subjects with a high risk of gastrointestinal problems, either a non-selective NSAID and gastroprotection or a coxib should be prescribed. In subjects with a high risk of cardiovascular problems, coxibs are contraindicated and non-selective NSAIDs should be used with caution.

• Non-pharmacological treatments include patient education, exercises, assistive aids (canes) and weight loss.
• In case of contraindications, intolerance or ineffectiveness of NSAIDs, opioids are indicated
• Local topical medication (NSAIDs, capsaicin) is effective and well tolerated.
• Corticosteroid injections are indicated for painful flare-ups, particularly with effusion.
• Arthroplasty should be considered in cases of refractory pain associated with disability and radiological destruction.
• SYSADOAs (glucosamine, chondroitin sulphate, diacerein, unsaponifiable extracts of avocado or soya and hyaluronic acid) have symptomatic effects and are likely to lead to structural changes.

• Non-pharmacological treatments include patient education, exercises, assistive aids (canes) and weight loss (if the patient is overweight).
• In case of contraindications, intolerance or ineffectiveness of NSAIDs, opioids are indicated
• Corticosteroid injections can be considered for patients suffering from an evolutionary flare-up unresponsive to analgesics and/or NSAIDs.
• Preventive surgery may be considered in young adults suffering from osteoarthritis caused by hip dysplasia.
• Arthroplasty may be considered in patients with confirmed hip osteoarthritis suffering from intractable pain or disability.
• SYSADOAs have a symptomatic effect and low toxicity, but the effects are minimal, patients likely to benefit most have not been identified. The structural changes and clinically significant pharmacoeconomic benefits have not been properly established.

• Orthotics for rhizarthrosis and those intended to prevent or correct deformities are recommended.
• Local topical medication (NSAIDs, capsaicin) is effective and well tolerated.
• Corticosteroid injections are effective for flare-ups.
• Surgery is effective for severe rhizarthrosis of the thumb and should be considered in the event of failure of the medical treatment.

Bibliography
- Zhang W et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCI-SIT). Ann Rheum Dis 2005; 64 : 669-81.
- Zhang W et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCI-SIT). Ann Rheum Dis 2007; 66: 377-88.
- Jordan KM et al. EULAR recommendation 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutics (ESCI-SIT). Ann Rheum Dis 2003; 62: 1145-55.