EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

• Published in: Annals of the rheumatic diseases Vol. 62; no. 12; pp. 1145 - 1155
• Main Authors: Jordan, K M, Arden, N K, Doherty, M, Bannwarth, B, Bijlsma, J W J, Dieppe, P, Gunther, K, Hauselmann, H, Herrero-Beaumont, G, Kaklamanis, P, Lohmander, S, Leeb, B, Lequesne, M, Mazieres, B, Martin-Mola, E, Pavelka, K, Pendleton, A, Punzi, L, Serni, U, Swoboda, B, Verbruggen, G, Zimmerman-Gorska, I, Dougados, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.12.2003; BMJ; BMJ Publishing Group Ltd; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - administration & dosage; Analgesics; Analgesics - therapeutic use; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis; Arthroplasty, Replacement, Knee; Biological and medical sciences; Clinical Medicine; Clinical Trials as Topic; Committees; Delayed-Action Preparations; Disability; Diseases of the osteoarticular system; effect size; Evidence-Based Medicine; Exercise Therapy; Extended Report; guidelines; Health Education; Humans; hyaluronic acid; Joint surgery; Klinisk medicin; Knee; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; non-steroidal anti-inflammatory drugs; NSAIDs; Orthopedic Equipment; Osteoarthritis; Osteoarthritis, Knee - therapy; Practice Guidelines as Topic; quality score; randomised controlled trial; RCT; recommendations; Risk Factors; TKR; total knee replacement; Transcutaneous electrical nerve stimulation-TENS; treatment; Weight Loss; Knee; Human; Treatment; Diseases of the osteoarticular system; Arthropathy; Degenerative disease; Osteoarthritis; Recommendation
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/ard.2003.011742

Objectives: To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach. Methods: The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality. Results: 497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research. Conclusion: The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered.