Osteoarthritis treatment in practice falls short of EULAR guidelines

Osteoarthritis is a leading cause of chronic pain, often affecting physical function, daily activities, and quality of life. EULAR - The European Alliance of Associations for Rheumatology - has developed recommendations and clinical practice guidelines for the management of osteoarthritis in the hand, hip, and knee. But people are often treated by different healthcare professionals, and there is little knowledge about which specialists see patients in which phase of the disease - and whether the guidelines are implemented in real-world settings.

In a session at the 2025 EULAR congress in Barcelona, important findings were presented from the BLOAR registry, taking in data from 1,716 people with osteoarthritis treated in everyday clinical practice in Austria. This registry collects comprehensive clinical and demographic information from physicians and therapists, as well as patient-reported outcomes such as information on pain, quality of life, physical activity, and disease severity.

The findings show that most people are being treated for osteoarthritis in the knee (52.2%), followed by hand (23.5%), hip (17.7%), and other joints (6.7%). Over 80% were moderately or severely affected by their disease, and 16% reported having reduced their workhours or lost their job. On a scale of 1-100, pain was on average 24.7 at rest, and 42.8 during activity.

Overall, 67.0% reported consultations and visits to doctors; 61.4% had received physiotherapy (active, functional therapy with a licensed physiotherapist) and 60.4% had physical therapy (medically prescribed passive modalities such as electrotherapy, heat, cold, ultrasound, or hydrotherapy). However, surprisingly, only 11.8% reported having received dietary interventions and weight management programs. Only 37.5% were using medications, including pain-relief, but many people were taking vitamins (40.3%) and plant-based products (12.6%).

The results show a significant gap between real-world practice and the existing EULAR recommendations. Interventions around weight management are strongly emphasized in the guidelines, which state that "people with hip or knee osteoarthritis should be offered education on the importance of maintaining a healthy weight; those overweight or obese should be offered support to achieve and maintain weight loss", but in real-world settings these approaches are not being used, with only about 10% of patients receiving such support.

While close to 70% of patients receive consultations and physiotherapy or physical therapy, there is a high prevalence of non-evidence-based treatments, such as taking vitamins and plant-based products - neither of which are recommended by EULAR - and this is surprising."

Valentina Schmolik

The authors say these findings from BLOAR underscore the need to raise awareness of evidence-based interventions in clinical practice, and to implement them more effectively.

Healthcare providers should prioritize aligning treatment approaches with established guidelines to optimise outcomes for people with osteoarthritis. Furthermore, the popularity of non-standardised treatments suggests the importance of understanding patient preferences and addressing misconceptions through targeted education and communication strategies.