OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

被引：2678

作者：

Bannuru, R. R. ^{[1
]}

Osani, M. C. ^{[1
]}

Vaysbrot, E. E. ^{[1
]}

Arden, N. K. ^{[2
,3
]}

Bennell, K. ^{[4
]}

Bierma-Zeinstra, S. M. A. ^{[5
,6
]}

Kraus, V. B. ^{[7
,8
]}

Lohmander, L. S. ^{[9
]}

Abbott, J. H. ^{[10
]}

Bhandari, M. ^{[11
]}

Blanco, F. J. ^{[12
,13
]}

Espinosa, R. ^{[14
,15
]}

Haugen, I. K. ^{[16
]}

Lin, J. ^{[17
]}

Mandl, L. A. ^{[18
]}

Moilanen, E. ^{[19
,20
]}

Nakamura, N. ^{[21
]}

Snyder-Mackler, L. ^{[22
]}

Trojian, T. ^{[23
]}

Underwood, M. ^{[24
,25
]}

McAlindon, T. E. ^{[1
]}

机构：

[1] Tufts Med Ctr, Div Rheumatol, CTCIA, Box 406,800 St, Boston, MA 02111 USA

[2] Univ Oxford, Ctr Sport Exercise & Osteoarthrit Res Versus Arth, Nottingham, England

[3] Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England

[4] Univ Melbourne, Dept Physiotherapy, Ctr Hlth Exercise & Sports Med, Carlton, Vic, Australia

[5] Univ Med Ctr Rotterdam, Erasmus MC, Dept Gen Practice, Rotterdam, Netherlands

[6] Univ Med Ctr Rotterdam, Erasmus MC, Dept Orthoped, Rotterdam, Netherlands

[7] Duke Univ, Sch Med, Dept Med, Duke Mol Physiol Inst, Durham, NC 27706 USA

[8] Duke Univ, Sch Med, Dept Med, Div Rheumatol, Durham, NC 27706 USA

[9] Lund Univ, Dept Clin Sci, Orthoped, Lund, Sweden

[10] Univ Otago, Dunedin Sch Med, Dept Surg Sci, CMOR, Dunedin, New Zealand

[11] McMaster Univ, Dept Orthoped Surg, Hamilton, ON, Canada

[12] Hosp Univ, INIBIC, Grp Invest Reumatol, La Coruna, La Coruna, Spain

[13] Univ A Coruna, INIBIC, CICA, La Coruna, La Coruna, Spain

[14] Natl Inst Rehabil, Mexico City, DF, Mexico

[15] Univ Nacl Autonoma Mexico, Mexico City, DF, Mexico

[16] Diakonhjemmet Hosp, Dept Rheumatol, Oslo, Norway

[17] Peking Univ, Peoples Hosp, Arthrit Clin & Res Ctr, Beijing, Peoples R China

[18] Weill Cornell Med, Hosp Special Surg, New York, NY USA

[19] Tampere Univ, Fac Med & Hlth Technol, Immunopharmacol Res Grp, Tampere, Finland

[20] Tampere Univ Hosp, Tampere, Finland

[21] Osaka Hlth Sci Univ, Inst Med Sci Sports, Osaka, Japan

[22] Univ Delaware, STAR, Dept Phys Therapy, Newark, DE USA

[23] Drexel Sports Med, Div Sports Med, Philadelphia, PA USA

[24] Warwick Med Sch, Warwick Clin Trials Unit, Coventry, W Midlands, England

[25] Univ Hosp Coventry & Warwickshire, Coventry, W Midlands, England

来源：

OSTEOARTHRITIS AND CARTILAGE | 2019年 / 27卷 / 11期

关键词：

Osteoarthritis; Clinical practice guidelines; Knee; Hip; Non-surgical management; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; PRODUCTIVITY COSTS; CHRONIC PAIN; RECOMMENDATIONS; GRADE; CONSENSUS; EVENTS; IMPACT; ABUSE;

D O I：

10.1016/j.joca.2019.06.011

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

100224 [整形外科学];

摘要：

Objective: To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data. Methods: We sought evidence for 60 unique interventions. A systematic search of all relevant databases was conducted from inception through July 2018. After abstract and full-text screening by two independent reviewers, eligible studies were matched to PICO questions. Data were extracted and meta-analyses were conducted using RevMan software. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence Profiles were compiled using the GRADEpro web application. Voting for Core Treatments took place first. Four subsequent voting sessions took place via anonymous online survey, during which Panel members were tasked with voting to produce recommendations for all joint locations and comorbidity classes. We designated non-Core treatments to Level 1A, 1B, 2, 3, 4A, 4B, or 5, based on the percentage of votes in favor, in addition to the strength of the recommendation. Results: Core Treatments for Knee OA included arthritis education and structured land-based exercise programs with or without dietary weight management. Core Treatments for Hip and Polyarticular OA included arthritis education and structured land-based exercise programs. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were strongly recommended for individuals with Knee OA (Level 1A). For individuals with gastrointestinal comorbidities, COX-2 inhibitors were Level 1B and NSAIDs with proton pump inhibitors Level 2. For individuals with cardiovascular comorbidities or frailty, use of any oral NSAID was not recommended. Intra-articular (IA) corticosteroids, IA hyaluronic acid, and aquatic exercise were Level 1B/Level 2 treatments for Knee OA, dependent upon comorbidity status, but were not recommended for individuals with Hip or Polyarticular OA. The use of Acetaminophen/Paracetamol (APAP) was conditionally not recommended (Level 4A and 4B), and the use of oral and transdermal opioids was strongly not recommended (Level 5). A treatment algorithm was constructed in order to guide clinical decision-making for a variety of patient profiles, using recommended treatments as input for each decision node. Conclusion: These guidelines offer comprehensive and patient-centered treatment profiles for individuals with Knee, Hip, and Polyarticular OA. The treatment algorithm will facilitate individualized treatment decisions regarding the management of OA. (C) 2019 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

引用

页码：1578 / 1589

页数：12

共 39 条

[1]

GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations [J].

Andrews, Jeff ;

Guyatt, Gordon ;

Oxman, Andrew D. ;

Alderson, Phil ;

Dahm, Philipp ;

Falck-Ytter, Yngve ;

Nasser, Mona ;

Meerpohl, Joerg ;

Post, Piet N. ;

Kunz, Regina ;

Brozek, Jan ;

Vist, Gunn ;

Rind, David ;

Akl, Elie A. ;

Schuenemann, Holger J. .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2013, 66 (07) :719-725

[2]

GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength [J].

Andrews, Jeffrey C. ;

Schuenemann, Holger J. ;

Oxman, Andrew D. ;

Pottie, Kevin ;

Meerpohl, Joerg J. ;

Coello, Pablo Alonso ;

Rind, David ;

Montori, Victor M. ;

Brito, Juan Pablo ;

Norris, Susan ;

Elbarbary, Mahmoud ;

Post, Piet ;

Nasser, Mona ;

Shukla, Vijay ;

Jaeschke, Roman ;

Brozek, Jan ;

Djulbegovic, Ben ;

Guyatt, Gordon .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2013, 66 (07) :726-735

[3]

[Anonymous], 2015, GRADEpro GDT: GRADEpro Guideline Development Tool [Software]

[4]

Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data [J].

Bally, Michele ;

Dendukuri, Nandini ;

Rich, Benjamin ;

Nadeau, Lyne ;

Helin-Salmivaara, Arja ;

Garbe, Edeltraut ;

Brophy, James M. .

BMJ-BRITISH MEDICAL JOURNAL, 2017, 357

[5]

Differences in cardiovascular safety with non-steroidal anti-inflammatory drug therapy-A nationwide study in patients with osteoarthritis [J].

Barcella, Carlo Alberto ;

Lamberts, Morten ;

McGettigan, Patricia ;

Fosbol, Emil Loldrup ;

Lindhardsen, Jesper ;

Torp-Pedersen, Christian ;

Gislason, Gunnar Hilmar ;

Olsen, Anne-Marie Schjerning .

BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY, 2019, 124 (05) :629-641

[6]

Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials [J].

Bhala, N. ;

Emberson, J. ;

Merhi, A. ;

Abramson, S. ;

Arber, N. ;

Baron, J. A. ;

Bombardier, C. ;

Cannon, C. ;

Farkouh, M. E. ;

FitzGerald, G. A. ;

Goss, P. ;

Halls, H. ;

Hawk, E. ;

Hawkey, C. ;

Hennekens, C. ;

Hochberg, M. ;

Holland, L. E. ;

Kearney, P. M. ;

Laine, L. ;

Lanas, A. ;

Lance, P. ;

Laupacis, A. ;

Oates, J. ;

Patrono, C. ;

Schnitzer, T. J. ;

Solomon, S. ;

Tugwell, P. ;

Wilson, K. ;

Wittes, J. ;

Baigent, C. ;

Adelowo, O. ;

Aisen, P. ;

Al-Quorain, A. ;

Altman, R. ;

Bakris, G. ;

Baumgartner, H. ;

Bresee, C. ;

Carducci, M. ;

Chang, D-M. ;

Chou, C-T. ;

Clegg, D. ;

Cudkowicz, M. ;

Doody, L. ;

El Miedany, Y. ;

Falandry, C. ;

Farley, J. ;

Ford, L. ;

GarciLosa, M. ;

Gonzalez-Ortiz, M. ;

Haghighi, M. .

LANCET, 2013, 382 (9894) :769-779

[7]

Chronic non-cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013 [J].

Birke, H. ;

Kurita, G. P. ;

Sjogren, P. ;

Hojsted, J. ;

Simonsen, M. K. ;

Juel, K. ;

Ekholm, O. .

ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2016, 60 (05) :623-633

[8]

Cochrane Collaboration, COCHR RISK BIAS TOOL

[9]

Cohen JW., 1988, STAT POWER ANAL BEHA, DOI 10.4324/9780203771587

[10]

The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study [J].

Cross, Marita ;

Smith, Emma ;

Hoy, Damian ;

Nolte, Sandra ;

Ackerman, Ilana ;

Fransen, Marlene ;

Bridgett, Lisa ;

Williams, Sean ;

Guillemin, Francis ;

Hill, Catherine L. ;

Laslett, Laura L. ;

Jones, Graeme ;

Cicuttini, Flavia M. ;

Osborne, Richard ;

Vos, Theo ;

Buchbinder, Rachelle ;

Woolf, Anthony ;

March, Lyn .

ANNALS OF THE RHEUMATIC DISEASES, 2014, 73 (07) :1323-1330

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