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An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
Objectives

Existing practice guidelines for osteoarthritis (OA) analyze the evidence behind each proposed treatment but do not prioritize the interventions in a given sequence. The objective was to develop a treatment algorithm recommendation that is easier to interpret for the prescribing physician based on the available evidence and that is applicable in Europe and internationally. The knee was used as the model OA joint.

Methods

ESCEO assembled a task force of 13 international experts (rheumatologists, clinical epidemiologists, and clinical scientists). Existing guidelines were reviewed; all interventions listed and recent evidence were retrieved using established databases. A first schematic flow chart with treatment prioritization was discussed in a 1-day meeting and shaped to the treatment algorithm. Fine-tuning occurred by electronic communication and three consultation rounds until consensus.

Results

Basic principles consist of the need for a combined pharmacological and non-pharmacological treatment with a core set of initial measures, including information access/education, weight loss if overweight, and an appropriate exercise program. Four multimodal steps are then established. Step 1 consists of background therapy, either non-pharmacological (referral to a physical therapist for re-alignment treatment if needed and sequential introduction of further physical interventions initially and at any time thereafter) or pharmacological. The latter consists of chronic Symptomatic Slow-Acting Drugs for OA (e.g., prescription glucosamine sulfate and/or chondroitin sulfate) with paracetamol at-need; topical NSAIDs are added in the still symptomatic patient. Step 2 consists of the advanced pharmacological management in the persistent symptomatic patient and is centered on the use of oral COX-2 selective or non-selective NSAIDs, chosen based on concomitant risk factors, with intra-articular corticosteroids or hyaluronate for further symptom relief if insufficient. In Step 3, the last pharmacological attempts before surgery are represented by weak opioids and other central analgesics. Finally, Step 4 consists of end-stage disease management and surgery, with classical opioids as a difficult-to-manage alternative when surgery is contraindicated.

Conclusions

The proposed treatment algorithm may represent a new framework for the development of future guidelines for the management of OA, more easily accessible to physicians.
algorithm, knee osteoarthritis
0049-0172
253-263
Bruyere, O.
9c455ea4-7f77-407f-ab5a-ecb571db8245
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Pelletier, J.P.
6ede80e5-dcc8-4b0c-a292-792f067b8ace
Branco, J.
f1c58fe8-c26b-4d12-8205-253b0fcd3ff4
Brandi, M.L.
4147f967-9c22-494d-ae35-c8141161413d
Guillemin, F.
4b8e048f-bef0-4ecb-8cd6-662608ecff46
Hochberg, M.C.
f547e7ff-3b03-4391-8404-3878675f9bf7
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Kiven, T.K.
39fafdea-71ec-46cd-aff2-67d83f9196e7
Martel-Pelletier, J.
f35bfb7f-d2c4-4f42-8218-cfdad2fc55b7
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Silverman, S.
dfe0f214-17ef-41de-b403-7e2b3105f178
Reginster, J.Y.
4083b457-5347-4ece-a53e-af19c8868c42
Bruyere, O.
9c455ea4-7f77-407f-ab5a-ecb571db8245
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Pelletier, J.P.
6ede80e5-dcc8-4b0c-a292-792f067b8ace
Branco, J.
f1c58fe8-c26b-4d12-8205-253b0fcd3ff4
Brandi, M.L.
4147f967-9c22-494d-ae35-c8141161413d
Guillemin, F.
4b8e048f-bef0-4ecb-8cd6-662608ecff46
Hochberg, M.C.
f547e7ff-3b03-4391-8404-3878675f9bf7
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Kiven, T.K.
39fafdea-71ec-46cd-aff2-67d83f9196e7
Martel-Pelletier, J.
f35bfb7f-d2c4-4f42-8218-cfdad2fc55b7
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Silverman, S.
dfe0f214-17ef-41de-b403-7e2b3105f178
Reginster, J.Y.
4083b457-5347-4ece-a53e-af19c8868c42

Bruyere, O., Cooper, C., Pelletier, J.P., Branco, J., Brandi, M.L., Guillemin, F., Hochberg, M.C., Kanis, J.A., Kiven, T.K., Martel-Pelletier, J., Rizzoli, R., Silverman, S. and Reginster, J.Y. (2014) An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Seminars in Arthritis and Rheumatism, 44 (3), 253-263. (doi:10.1016/j.semarthrit.2014.05.014). (PMID:24953861)

Record type: Article

Abstract

Objectives

Existing practice guidelines for osteoarthritis (OA) analyze the evidence behind each proposed treatment but do not prioritize the interventions in a given sequence. The objective was to develop a treatment algorithm recommendation that is easier to interpret for the prescribing physician based on the available evidence and that is applicable in Europe and internationally. The knee was used as the model OA joint.

Methods

ESCEO assembled a task force of 13 international experts (rheumatologists, clinical epidemiologists, and clinical scientists). Existing guidelines were reviewed; all interventions listed and recent evidence were retrieved using established databases. A first schematic flow chart with treatment prioritization was discussed in a 1-day meeting and shaped to the treatment algorithm. Fine-tuning occurred by electronic communication and three consultation rounds until consensus.

Results

Basic principles consist of the need for a combined pharmacological and non-pharmacological treatment with a core set of initial measures, including information access/education, weight loss if overweight, and an appropriate exercise program. Four multimodal steps are then established. Step 1 consists of background therapy, either non-pharmacological (referral to a physical therapist for re-alignment treatment if needed and sequential introduction of further physical interventions initially and at any time thereafter) or pharmacological. The latter consists of chronic Symptomatic Slow-Acting Drugs for OA (e.g., prescription glucosamine sulfate and/or chondroitin sulfate) with paracetamol at-need; topical NSAIDs are added in the still symptomatic patient. Step 2 consists of the advanced pharmacological management in the persistent symptomatic patient and is centered on the use of oral COX-2 selective or non-selective NSAIDs, chosen based on concomitant risk factors, with intra-articular corticosteroids or hyaluronate for further symptom relief if insufficient. In Step 3, the last pharmacological attempts before surgery are represented by weak opioids and other central analgesics. Finally, Step 4 consists of end-stage disease management and surgery, with classical opioids as a difficult-to-manage alternative when surgery is contraindicated.

Conclusions

The proposed treatment algorithm may represent a new framework for the development of future guidelines for the management of OA, more easily accessible to physicians.

Other
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More information

Published date: December 2014
Keywords: algorithm, knee osteoarthritis
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 373542
URI: http://eprints.soton.ac.uk/id/eprint/373542
ISSN: 0049-0172
PURE UUID: f4ff7128-6449-484c-9244-c848dbb1aa25
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 21 Jan 2015 15:26
Last modified: 18 Mar 2024 02:45

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Contributors

Author: O. Bruyere
Author: C. Cooper ORCID iD
Author: J.P. Pelletier
Author: J. Branco
Author: M.L. Brandi
Author: F. Guillemin
Author: M.C. Hochberg
Author: J.A. Kanis
Author: T.K. Kiven
Author: J. Martel-Pelletier
Author: R. Rizzoli
Author: S. Silverman
Author: J.Y. Reginster

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