EXTENDED REPORT

Level of acceptability of EULAR recommendations for the management of knee osteoarthritis by practitioners in different European countries

B Mazières¹, N Scmidely², H J Hauselmann³, E Martin-Mola⁴, U Serni⁵, A A Verbruggen⁶, M Le Bars²

¹ University Hospital of Rangueil, Toulouse, France
² Bristol–Myers Squibb Company, Rueil-Malmaison, France
³ Centre for Rheumatology and Bone Disease, Zurich, Switzerland
⁴ Hospital La Paz, Madrid, Spain
⁵ Istituto Ortopedico Toscano, Firenze, Italy
⁶ Universiteit Ziekenhuis, Gent, Belgium

Correspondence to:
Professor B Mazières
Department of Rheumatology, University Hospital of Rangueil, 1 Avenue Jean-Poulhès, 31059 Toulouse Cedex 9, France; mazieres{at}cict.fr

Objective: To evaluate the level of acceptability of the EULAR recommendations for the management of knee osteoarthritis (KOA) in practice.

Methods: A questionnaire was sent to general practitioners, rheumatologists, rehabilitators, and orthopaedic surgeons in five European countries (France, Spain, Belgium, Switzerland, Italy). Practitioners were asked to give their opinion on the 10 EULAR recommendations and on 23 treatment modes for KOA. Practitioners’ opinions were compared with those of the expert task force involved in the development of these recommendations.

Results: The overall response rate was 10.4% (4204 replies). Results were similar across countries and specialties. Of the 23 treatment modes proposed, only joint lavage and intra-articular (IA) corticosteroid injections were more strongly recommended by the expert task force than by the responders as a whole, while the opposite was true for spa therapy. Principal component analysis showed: (1) some practitioners preferred "hard line" treatments (surgery, IA injections, or non-steroidal anti-inflammatory drugs (NSAIDs)); (2) there was a difference between those prescribing pharmacological (paracetamol) or non-pharmacological measures with low iatrogenicity (exercises, sticks, education), and those prescribing less well validated treatments closer to "alternative" medicine; (3) each specialist tended to advocate modes that they were most familiar with: rheumatologists were more likely to recommend IA injections and NSAIDs; orthopaedic surgeons, surgical procedures; rehabilitators, education and all non-pharmacological modes; general practitioners, spa therapy and opioids.

Conclusions: A multidisciplinary approach is optimal in the management of this chronic disease with its variable course.

Abbreviations: EULAR, European League Against Rheumatism; KOA, knee osteoarthritis; PCA, principal components analysis; VAS, visual analogue scale

Keywords: knee osteoarthritis; management; EULAR recommendations

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