Draft guidelines for the management of hip and knee osteoarthritis (OA) demonstrate the urgent need for better quality evidence regarding pharmacological and non-pharmacological interventions.

Most recommendations, both for and against particular interventions, were based on low or very low quality evidence according to the rigorous GRADE process.

Some of the highest level of evidence – at only moderate – was for land-based exercise for hip OA, oral NSAIDs for hip or knee OA, duloxetine for knee OA and against strontium ranelate for both hip and knee OA.

Guideline development working group co-chair Professor David Hunter told the limbic the methodology included critical appraisal of many aspects of quality including risk of bias, inconsistency between studies, directness of evidence and imprecision.

“It is important to note that many of the studies in the literature are not of high quality. This is not unique to osteoarthritis but something people conducting clinical trials should be aware of with regards to improving the quality of future trials.”

The strongest positive recommendations in the guidelines were for weight management and land-based exercise for both hip and knee OA – issues that many clinicians found difficult.

“While the principal target of the guidelines is GPs we are also interested in disseminating this information to other health professionals involved in osteoarthritis management.

These recommendations emphasise the need for appropriate engagement, care plans that facilitate adherence and appropriate referral to exercise professionals and dietitians,” Professor Hunter said.

Some of strongest negative recommendations in the guidelines were against oral and transdermal opioids, doxycycline, IL-1 inhibitors, fibroblast growth factor and stem cell therapy for both hip and knee OA.

The consultation period closes at 5pm Wednesday, 20 December.