ORIGINAL ARTICLEEULAR recommendations for the management of knee osteoarthritis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials1
Section snippets
Recommendations …
Clinical guidelines were defined by the Institute of Medicine in Washington 〚1〛 as “Systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical conditions.” These recommendations appeared about 10 years ago (more than 230 papers on Medline for the January-November 2000 period only). In France, ANAES (Agence Nationale dˈAccréditation et dˈEvaluation en Santé: National Agency for Health Assessment and Accreditation) regularly
…in osteoarthritis
Osteoarthritis (OA) is by far the most common disease to affect synovial joints. It is a major cause of pain and disability. Its cost – estimated in France at more than 6 billion francs in 1993 〚2〛 – poses a community health care problem. With the increasing proportion of elderly people in the population, OA will become an even more important challenge.
OA of the knees is particularly common, with radiographic OA of the tibio-femoral compartment occurring in 5 to 15% of persons aged 35–74 years.
The task force
A task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutic Trials was created in September 1998. It involved a committee of 21 experts in the field of osteoarthritis (rheumatologists and orthopaedic surgeons) representing 13 different European countries together with two experts in the field of guidelines methodology and one pharmacologist (table I).
The objectives of the Committee were: 1) to describe the therapies available for the treatment of knee
Methods
The first step was to produce a comprehensive list of treatment modalities to be included in the review process.
The second step was a systematic search conducted using two databases, Medline Ovid and Bids Embase. All European-language publications in the form of clinical trials and meta-analyses were included. The searches were conducted for the period January–December 1966-1998 and were last performed in July 1999. The methodological quality of each study was scored (from 0 to 28) according to
The list of the 23 treatment modalities
Ten of these modalities are non-pharmacological, nine concern pharmacological tools and four are surgical procedures. Topical (percutaneous) therapy includes NSAIDs and capsaicine or other local analgesics not marketed in France. Vitamins and mineral salts are grouped as ‘nutrients’ (table IV).
Evidence-based approach
Two thousand eight hundred and ninety-two studies were identified by the search strategy; 744 were intervention trials involving knee osteoarthritis. Six hundred and eighty of these trials involved at
Discussion
These are the first clinical guidelines on knee OA to be developed by EULAR. An evidence-based approach was specifically chosen by the Task Force. This was to minimise the potential limitations of ‘expert opinion’ alone 〚50〛 and to permit, wherever possible, calculation of effect sizes and NNT to allow comparison of efficacy between diverse forms of treatment.
Despite the strengths of this method of guideline development a number of caveats deserve emphasis. Although we employed a traditional
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2015, Clinical BiomechanicsCitation Excerpt :On the other hand, analgesic intake in the intervention group remained unchanged after the third month, and significantly lower than controls. This is a satisfactory result, since the European League Against Rheumatism (Mazieres et al., 2001) considers that reduction of this type of medication has health benefits in OA treatment. Throughout the six months, the increased paracetamol intake by the control group compared to the intervention group can be explained by a possible pain increased caused by the increasing of 15.4% in KAM peak suffered only by the group which did not wear the Moleca® footwear (within-group).
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This paper is a short and commented version of the article from Pendleton A, Arden N, Dougados M, et al. EULAR recommendations for the management of knee osteoarthritis. Ann Rheum Dis 2000 : 59 : 936-44.