University of Oulu

Arden, N.K., Perry, T.A., Bannuru, R.R. et al. Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nat Rev Rheumatol 17, 59–66 (2021).

Non-surgical management of knee osteoarthritis : comparison of ESCEO and OARSI 2019 guidelines

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Author: Arden, Nigel K.1,2,3; Perry, Thomas A.1; Bannuru, Raveendhara R.4;
Organizations: 1Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
3WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
4Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
5Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, 4000, Liège, Belgium
6Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
7Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
8Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
9Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
10Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
11Department of Rheumatology, UMC Utrecht, Utrecht, Netherlands
12Department of Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
13Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: Springer Nature, 2021
Publish Date: 2021-04-28


Knee osteoarthritis (OA) is a heterogeneous disease associated with substantial effects on quality of life, and its clinical management is difficult. Among the several available guidelines for the management of knee OA, those from OARSI and ESCEO were updated in 2019. Here, we examine the similarities and differences between these two guidelines and provide a narrative to help guide health-care providers through the complexities of non-surgical management of knee OA. OARSI and ESCEO both recommend education, structured exercise and weight loss as core treatments, topical NSAIDs as first-line treatments and oral NSAIDs and intra-articular injections for persistent pain. Low-dose, short-term acetaminophen, pharmaceutical grade glucosamine and chondroitin sulfate are recommended by ESCEO whereas OARSI strongly recommends against their use (including all glucosamine and chondroitin formulations). Despite this difference, the two guidelines are consistent in the majority of their recommendations and provide useful treatment recommendations for individuals with OA and health-care providers.

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Series: Nature reviews. Rheumatology
ISSN: 1759-4790
ISSN-E: 1759-4804
ISSN-L: 1759-4790
Volume: 17
Pages: 59 - 66
DOI: 10.1038/s41584-020-00523-9
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The working group was entirely funded by ESCEO. To support its educational and scientific activities, ESCEO receives unrestricted educational grants from non-governmental organizations, not-for-profit organizations, and non-commercial and corporate partners. The choice of topics, participants, content and agenda of the working group, as well as the writing, editing, submission and reviewing of the manuscript are the sole responsibility of ESCEO, without any influence from third parties. ESCEO is supported by the Chair for Biomarkers of Chronic Diseases and the International Scientific Partnership Program (ISPP#0111) at King Saud University, Riyadh, Saudi Arabia.
Copyright information: © 2020 Springer Nature. This is a post-peer-review, pre-copyedit version of an article published in Nat Rev Rheumatol. The final authenticated version is available online at