Rethinking Osteoarthritis Treatments: A Call for Evidence-Based Approaches

Osteoarthritis stands as a predominant cause of chronic pain, significantly impacting physical function, daily activities, and overall quality of life. The European Alliance of Associations for Rheumatology (EULAR) has established guidelines and recommendations aimed at the effective management of osteoarthritis, specifically targeting the hand, hip, and knee.

Despite these guidelines, there appears to be a disconnect in the treatment practices among various healthcare professionals. Concerns have been raised regarding a lack of clarity about which specialists are involved in patient care during different stages of the disease and whether established guidelines are being adhered to in practical settings.

During the recent EULAR congress held in Barcelona in 2025, significant insights from the BLOAR registry were presented, encompassing data from 1,716 individuals diagnosed with osteoarthritis who were treated in typical clinical environments across Austria. This registry gathers extensive clinical and demographic information from healthcare providers and therapists, along with patient-reported outcomes that include metrics on pain levels, quality of life, physical activity, and disease severity.

The data revealed that the majority of patients were receiving treatment for knee osteoarthritis (52.2%), followed by hand (23.5%), hip (17.7%), and other joint issues (6.7%). Alarmingly, over 80% of these patients reported experiencing moderate to severe symptoms related to their condition, with 16% indicating a reduction in work hours or job loss due to their illness. Pain levels were notably high, averaging 24.7 at rest and 42.8 during physical activity on a scale of 1 to 100.

Further analysis showed that 67% of patients had sought consultations with healthcare professionals, while 61.4% underwent active physical therapy with licensed therapists. Additionally, 60.4% of patients received medically prescribed passive therapies including electrotherapy, heat, cold, ultrasound, or hydrotherapy. However, only 11.8% reported having access to dietary interventions and weight management programs, despite the importance of these strategies in managing osteoarthritis.

Interestingly, while 37.5% of patients were utilizing pain-relief medications, a significant number opted for non-pharmaceutical alternatives, with 40.3% consuming vitamins and 12.6% using plant-based remedies. These findings highlight a concerning trend of reliance on treatments that lack scientific backing, as neither vitamins nor plant-based products are recommended by EULAR guidelines.

The data indicates a considerable gap between real-life treatment practices and the recommended EULAR interventions. The guidelines stress the critical role of weight management, advising that individuals with hip or knee osteoarthritis should receive education about maintaining a healthy weight and that those who are overweight or obese should be supported in their weight loss efforts. Yet, the real-world application of these recommendations is lacking, with merely around 10% of patients receiving proper guidance on weight management.

Healthcare professionals are urged to enhance their focus on evidence-based treatment methods, aligning their practices more closely with existing guidelines to improve outcomes for individuals suffering from osteoarthritis. The prevalence of non-standardized treatments also underscores the necessity for better understanding patient preferences and addressing any misunderstandings through targeted education and effective communication strategies.