Clinicians are not following standard care guidelines for their osteoarthritis (OA) patients, charge researchers who reviewed how standard clinical practice diverges from evidence-based recommendations in the management of OA.

“Despite remarkable consistency between recommendations and in spite of some dissemination attempts, clinical practice does not reflect these recommendations,” investigators wrote (Arthritis Care Res [Hoboken]. 2011;63:31-38).

Because there is no cure for OA, the main goal of current treatments is to reduce pain and improve joint function, but these agents do not help improve joint structure or otherwise ameliorate the disease over the long term. The researchers  found that clinicians frequently do not adequately recommend conservative nonpharmacologic management modalities. This leads to unnecessary imaging procedures and inappropriate referrals to orthopedic surgeons.

Most OA recommendations advocate weight management, as the majority of patients are overweight or obese. “However, in practice, weight management is not frequently implemented,” the researchers wrote. Similarly, exercise is routinely recommended, but clinical practice doesn’t reflect that.

On the imaging front, the researchers contended that such tests are inappropriately overused, given the fact that OA is primarily a clinical diagnosis made on the basis of history and physical examination. They reiterated that imaging should only be done when the diagnosis is unclear, and radiography can refute the presence of other conditions that may be causing the patient’s symptoms.