Ann Rheum Dis 69:12-19 doi:10.1136/ard.2008.104406
  • Recommendation

EULAR/EFORT recommendations for the diagnosis and initial management of patients with acute or recent onset swelling of the knee

  1. R B M Landewé1,
  2. K P Günther2,
  3. C Lukas3,
  4. J Braun4,
  5. B Combe5,
  6. P G Conaghan6,
  7. K Dreinhöfer7,
  8. D Fritschy8,
  9. J Getty9,
  10. H J L van der Heide10,
  11. T K Kvien11,
  12. K Machold12,
  13. C Mihai13,
  14. M Mosconi14,
  15. R Nelissen15,
  16. E Pascual16,
  17. K Pavelka17,
  18. M Pileckyte18,
  19. W Puhl19,
  20. L Punzi20,
  21. W Rüther21,
  22. M San-Julian22,
  23. C Tudisco23,
  24. R Westhovens24,
  25. E Witso25,
  26. D M F M van der Heijde26
  1. 1
    Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2
    Universitäts-Klinikum Carl Gustav Carus, Dresden, Germany
  3. 3
    Hospital Lapeyronie, Montpellier, France
  4. 4
    Rheumazentrum Ruhrgebiet, Herne, Germany
  5. 5
    Hospital Lapeyronie, Montpellier, France
  6. 6
    Chapel Allerton Hospital, Leeds, UK
  7. 7
    Universität Ulm, Ulm, Germany
  8. 8
    Hôpitaux Universitaires de Genève, Geneva, Switzerland
  9. 9
    British Orthopaedic Association, London, UK
  10. 10
    Leiden University Medical Center, Leiden, The Netherlands
  11. 11
    Diakonhjemmet Sykehus, Oslo, Norway
  12. 12
    Vienna Medical University, Vienna, Austria
  13. 13
    Cantacuzino Hospital, Bucharest, Romania
  14. 14
    IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
  15. 15
    Leiden University Medical Center, Leiden, The Netherlands
  16. 16
    Hospital General Universitario de Alicante, Alicante, Spain
  17. 17
    Institute of Rheumatology and Charles University, Prague, Czech Republic
  18. 18
    Hospital of Kaunas University of Medicine, Kaunas, Lithuania
  19. 19
    Klinik Oberstdorf, Oberstdorf, Germany
  20. 20
    University of Padova, Padova, Italy
  21. 21
    Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  22. 22
    University Clinic of Navarra, Pamplona, Spain
  23. 23
    University of Rome, Rome, Italy
  24. 24
    University Hospitals KU Leuven, Leuven, Belgium
  25. 25
    Norwegian Orthopaedic Association, Trondheim, Norway
  26. 26
    Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to R B M Landewé, Maastricht University Medical Center, Department of Internal Medicine/Rheumatology, PO Box 5800, 6202AZ Maastricht, The Netherlands; r.landewe{at}
  • Accepted 21 December 2008
  • Published Online First 15 January 2009


Objectives: The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of variation in diagnostic and therapeutic performance across disciplines, have found consensus in starting task forces aiming at achieving diagnostic and therapeutic uniformity, and have identified medical conditions with which representatives of both organisations will frequently be confronted in common clinical practice. The aim of the present work was to establish recommendations for the diagnosis and initial management of patients presenting with acute or recent onset swelling of the knee.

Methods: The EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations were followed.

Results: In all, 11 rheumatologists from 11 countries and 12 orthopaedic surgeons from 7 countries met twice under the leadership of 2 conveners, a clinical epidemiologist and a research fellow. After carefully defining the content and procedures of the task force, research questions were developed, a comprehensive literature search was performed and the results were presented to the entire committee. Subsequently, a set of 10 recommendations was formulated based on evidence from the literature if available, and after discussion and consensus building.

Conclusions: This is the first combined interdisciplinary project of rheumatologists and orthopaedic surgeons, successfully aiming at achieving consensus in the diagnosis and initial management of patients presenting with acute or recent onset swelling of the knee.


  • For numbered affiliations see end of article

  • Competing interests TKK: Hans Bijlsma was the handling editor for this article.

  • Provenance and Peer review Not commissioned; externally peer reviewed.