OARSI guidelines for the non-surgical management of knee osteoarthritis.

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 OA literature, 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.