TY - JOUR
T1 - OARSI guidelines for the non-surgical management of knee osteoarthritis
AU - McAlindon, T. E.
AU - Bannuru, R. R.
AU - Sullivan, M. C.
AU - Arden, N. K.
AU - Berenbaum, F.
AU - Bierma-Zeinstra, S. M.
AU - Hawker, G. A.
AU - Henrotin, Y.
AU - Hunter, D. J.
AU - Kawaguchi, H.
AU - Kwoh, K.
AU - Lohmander, S.
AU - Rannou, F.
AU - Roos, E. M.
AU - Underwood, M.
N1 - Funding Information:
This project was commissioned and funded by OARSI, yet was developed independently by the OARSI Treatment Guidelines Committee. The funding source did not participate in the literature search; determination of study eligibility criteria; voting process; data analysis or interpretation; or manuscript preparation. The manuscript was reviewed and approved by OARSI's Executive Committee prior to release for public comment.
Funding Information:
These guidelines were commissioned by the OARSI and sponsored by a grant from OARSI . This report is endorsed by the Board of Directors of OARSI; it was developed independently by the OARSI Guidelines Development Group.
Funding Information:
Full disclosure statements from all members of the OARSI Guidelines Development Group are shown in Appendix 1 . These were reviewed by the OARSI Ethics Committee. No potential conflicts of interest were identified that should preclude any member of the committee participating in this critical appraisal. No OAGDG members are employees of any pharmaceutical or medical device company. OAGDG members were recused from voting on select treatments where potential conflicts arose, as described in the report Methodology section. Corporate members of OARSI are also listed in Appendix 1 . The data extraction team included five members of the Division of Rheumatology, Tufts Medical Center, Boston, MA, USA: Raveendhara Bannuru MD, FAGE, Elizaveta Vaysbrot, MD, Matthew Sullivan, BA, Elena Manning, BS, and Bryan Bourdeau, BS. Dr Bannuru is supported by a F32 HS021396 grant from the Agency for Healthcare Research and Quality . The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Elizaveta Vaysbrot, Matthew Sullivan, Elena Manning, and Bryan Bourdeau have no conflicts of interest to disclose.
PY - 2014/3
Y1 - 2014/3
N2 - Objective: To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Method: Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OAliterature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Results: Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). Conclusion: These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences.
AB - Objective: To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Method: Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OAliterature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Results: Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). Conclusion: These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences.
KW - Knee osteoarthritis
KW - OARSI
KW - Treatment guidelines
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U2 - 10.1016/j.joca.2014.01.003
DO - 10.1016/j.joca.2014.01.003
M3 - Article
C2 - 24462672
AN - SCOPUS:84896690278
SN - 1063-4584
VL - 22
SP - 363
EP - 388
JO - Osteoarthritis and Cartilage
JF - Osteoarthritis and Cartilage
IS - 3
ER -