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:
Disclosure of potential conflicts of interest Name & specialty (in author-list order) Consulting fees, honoraria, research or institutional support, educational grants, equipment, services or expenses Research grants/contracts Service with organization with interests comparable to OARSI Recused from voting on the following treatment modalities T. McAlindon Rheumatologist; Epidemiologist Flexion Therapeutics|Consulting, Samumed|Consulting, Abbvie|Consulting, Sanofi|Consulting, Myrtus|Licensing fee NIH, Croma Co-editor for Arthritis & Rheumatism Hyaluronic acid R. Bannuru None AHRQ|F32 HS021396 grant None Not a voter M. Sullivan None None None Not a voter N. Arden ∗ Rheumatologist Merck|Consultancy, Roche|Consultancy, Smith and Nephew|Consultancy, Pfizer|Speaker Bureau, Flexion|Consultancy, Bioiberica|Consultancy, Speaker bureau NIHR|Outcomes of Arthroplasty and Biomedical Research Unit, NIH|Hip morphology, ARUK|VIDEO, project and equipment grants None Chondroitin Hyaluronic acid All surgery F. Berenbaum ∗ Rheumatologist Pfizer|Advisory board, Expanscience|Advisory board, UCB|Advisory board, Servier|Advisory board, research support, symposium, TRB Chemedica|research support, Sanofi|Advisory board, Abbott|Advisory board Agence Nationale Recherche French Society of Rheumatology NSAIDs S. Bierma-Zeinstra ∗ Physical therapist; Epidemiologist S. Bierma-Zeinstra (disclosure cont'd) None Dutch Arthritis Association|research in corticosteroids for OA, OA vascular pathology, early OA diagnosis, brace vs osteotomy treatment, & OA stepped care; The Netherlands Organization for Health Research and Development|research in identification, prevention of knee OA, OA phenotyping, treatment cost-effectiveness (ACL rupture, viscosupplementation, surgery vs conservative treatment in lumbar stenosis), corticosteroids for trochanteric pain syndrome, ankle injury complications, exercise after injury, & exercise therapy for patellofemoral pain syndrome; Nuts Ohra|research in X-ray OA diagnosis, OA pain medication, & statines & OA; EU FP7|markers for early detection & progression of OA None Glucosamine G. Hawker ∗ Rheumatologist Women's College Hospital|Physician in Chief of Medicine|Salary Support Award, Women's College Hospital Foundation|FM Hill Chair in Academic Women's Medicine. Nothing to declare Operating grants from the Canadian Institutes of Health Research|Canadian Arthritis Network|Cochrane Collaboration/writing paper with Adelphi, a marketing company who worked for Pfizer on a survey of physicians regarding factors that influence their perceptions of OA severity – unpaid None None Y. Henrotin ∗ Physical therapy & rehabilitation Bioiberica; BioXtract; Danone; Nestle; Pierre Fabre; Grunenthal; Expanscience; Artialis; Tilman; Merck; Ibsa|Honoraria. Patent ownership: Artialis|Biomarkers; Kit immunoassays|Development & commercialization of biomarkers of cartilage degradation & inflammation Walloon Government-Belgium|First Post-Doc RW/5291 PROMART-Recherche de nouveaux biomarqueurs (2007–2009).165.765; First Post-Doc RW/716609 CARTIMAT: Recherche de nouveaux biomateriaux; FIRST Entreprise - 73.726,4 Euros, European commission|FP7 D-Board, rd; Bioiberica & Expanscience|unrestricted educational grants None Chondroitin D. Hunter ∗ Rheumatologist DonJoy|Royalties; Merck Serono|Consulting, Flexion Therapeutics|Consulting Australian Research Council|Future Fellowship, NIH|POMA, NHMRC|project grants Bone and Joint Decade International Coordinating Council, Advisory editor for Arthritis Care and Research, Associate Editor for International Journal of Rheumatic Diseases Biomechanical interventions H. Kawaguchi ∗ Orthopedic surgeon Teijin Pharma Co., Ltd.|Consulting fee None BMC Musculoskeletal Disorders|Associate Editor, Japanese Orthopaedic Association|Committee Member, Japanese Society for Bone and Mineral Metabolism|Committee Member, Journal of Orthopaedic Science|Editorial Board, Journal of Bone &Mineral Metabolism|Editorial Board, Japanese Society of Cartilage Metabolism|Comm. Member Hyaluronic acid R. Katzanek Patient advocate Nothing to declare None None N/A K. Kwoh Rheumatologist Novartis|Advisory Board and DSMB, NIH|DSMB, Express Scripts|Consulting, Pfizer|RA Quality Measures Roundtable NIH|NIAMS P60AR054731 PITT-MCRC for rheumatic and musculoskeletal diseases; NIAMS N01AR-2-2260 Clinical centers for the Osteoarthritis Initiative; NHLBI HHSN26820100002 Pivotal OAI MRI Analyses (POMA); NIAMS R01AR056630 Single- vs Double-Bundle ACL Reconstruction: A Prospective Randomized Trial; NINR R01NR010904 Promoting Physical Activity in Older Adults with Co-morbidity; CDC|U48DP001918 Health Promotion and Disease Prevention Research Center Arthritis Foundation|Public Health Committee Glucosamine Risedronate S. Lohmander ∗ Orthopedic surgeon Merck Serono|Advisory board, Informed Medical Decision Making|Speaker honorarium, Össur Advisory Board, Abbott Consultancy, Flexion Therapeutics Advisory Board, Allergan Consultancy, Medivir Consultancy, Merrimack Pharmaceuticals Consultancy, Servier Consultancy Swedish Research Council|Lund University, Swedish Rheumatism Association|Lund University, Medical faculty|Lund University None Biomechanical interventions F. Rannou ∗ Rheumatologist Sanofi Aventis, Pfizer, Rottapharm, Pierre Fabre, Genzyme, Merck, Genévrier, Expanscience, Negma, Servier|Consulting/Advisory board AP-HP|Non-pharmacological treatments in rheumatic diseases, GSK|HO-1 inducer molecules in cartilage, Fondation de l'Avenir|Molecular mapping of IVD in scoliosis Member of the Eular Scientific Committee NSAIDs Hyaluronic acid ASU Diacerein E. Roos ∗ Physical therapist National Welfare Board, Sweden|Reviewer, National board for preventive medicine, Denmark|Board member, Össur|Lecture fees, Finnish Orthopedic Society|Lecture fees, Studentlitteratur|Royalties, Munksgaard|Royalties, Osteoarthritis and Cartilage|Associate Editor Southern Health Care Region, Denmark|RCT on exercise vs pharma, Danish Rheumatism Association|Knee OA prevention and treatment None None M. Underwood Primary care practitioner; primary care research Travel, Accommodation and Conference fee waiver from OARSI to attend OAGDG meetings concurrent with annual scientific meeting NIHR Programme grants|Improving outcomes from the treatment of back pain; Improving self-management of chronic pain, NHS HTA Programme|Prevention of Fall Injury Trial (Pre-FIT); Adherence to strengthening activities in rheumatoid arthritis of the hand (SARAH); Older People's Exercise intervention in Residential and nursing Accommodation (OPERA), National Centre for Osteopathic Research|Investigating osteopath's attitudes to managing and assessing risk in clinical settings and patient's experiences and responses, Research for Patient Benefit|Improving Patient Choice in Treating Low Back Pain (IMPACT - LBP). NHS Health Technology Assessment Programme. Facet joint feasibility study. National Institute for Health and Care Excellence (NICE)|Chair of Headache Guideline Development Group (2010–12). Chair NICE Accreditation Advisory Committee (2013) NICE Strategy Board, in attendance (2013) Acupuncture
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
UR - http://www.scopus.com/inward/record.url?scp=84896690278&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84896690278&partnerID=8YFLogxK
U2 - 10.1016/j.joca.2014.01.003
DO - 10.1016/j.joca.2014.01.003
M3 - Article
C2 - 24462672
AN - SCOPUS:84896690278
VL - 22
SP - 363
EP - 388
JO - Osteoarthritis and Cartilage
JF - Osteoarthritis and Cartilage
SN - 1063-4584
IS - 3
ER -