Background The highest burden of rheumatic disease in Colombia according to the Ministry of Health is due to Osteoarthritis (OA) and Rheumatoid Arthritis (RA). Currently we don´t have guidelines for the treatment of OA in our country.
Objectives To propose recommendations for treatment (medical and surgical) of hip, knee and hand OA based on both Evidence Based Medicine (EBM) and expert consensus approach.
Methods A task force of experts in Clinical Epidemiology and in OA research and management was created. The first stage was to assist a two-day course of guideline methodology. The second stage was the selection of treatment modalities and principal clinical questions to be considered. The third stage was a systematic literature review that permitted the ranking of the recommendations from A (based on results of meta-analyses) to E (negative recommendations based on results of meta-analyses). The final stage was recopilation and review of the consensus by an internal/external pair.
Results Different non-pharmacological and surgical modalities were evaluated.
Medical: Acetaminophen, NSAIDS and COXIBS were similar in efficacy to relieve pain (A). Gastrointestinal safety improves with COXIBS rather than the comparators (A). Hialuronate acid, glucosamine sulfate and NSAIDS were similar in efficacy to relieve pain (A-B).
Alternative: Yoga and acupuncture lessened pain and improved functional capacity (B-C).
Surgery: There is no recommendation for knee and hip artroplasty.
Conclusion The recommendations of this task force (1) the best evidence is in the treatment of pain; (2) currently there is no evidence for drugs modified disease; (3) certain alternative medicines are useful as coadyuvants and (4) this consensus is the base for new research.
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