2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.
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DOI：
10.1002/art.41142
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发表时间：
2020-02
影响因子：
13.3
通讯作者：
Reston, James
中科院分区：
文献类型：
--
作者：
Kolasinski, Sharon L.;Neogi, Tuhina;Hochberg, Marc C.;Oatis, Carol;Guyatt, Gordon;Block, Joel;Callahan, Leigh;Copenhaver, Cindy;Dodge, Carole;Felson, David;Gellar, Kathleen;Harvey, William F.;Hawker, Gillian;Herzig, Edward;Kwoh, C. Kent;Nelson, Amanda E.;Samuels, Jonathan;Scanzello, Carla;White, Daniel;Wise, Barton;Altman, Roy D.;DiRenzo, Dana;Fontanarosa, Joann;Giradi, Gina;Ishimori, Mariko;Misra, Devyani;Shah, Amit Aakash;Shmagel, Anna K.;Thoma, Louise M.;Turgunbaev, Marat;Turner, Amy S.;Reston, James
美国风湿病学会 (ACR) 和关节炎基金会合作，制定骨关节炎 (OA) 综合管理循证指南，更新 2012 年 ACR 关于手、髋和膝 OA 管理的建议。我们确定了 OA 中临床相关的人群、干预措施、比较器、结果问题和关键结果。文献综述小组进行了系统的文献综述，总结了支持 OA 现有教育、行为、社会心理、身体、身心和药物疗法的益处和危害的证据。使用建议评估、制定和评估的分级方法来评估证据的质量。由风湿病学家、内科医生、物理和职业治疗师以及患者组成的投票小组就这些建议达成了共识。根据现有证据，对所评估的方法提出了支持或反对的强烈或有条件的建议。强烈建议超重或肥胖的膝关节和/或髋关节骨关节炎患者进行锻炼、减肥、自我效能和自我管理计划、太极拳、手杖使用、治疗第一腕掌关节 (CMC) 关节骨关节炎的手部矫形器、治疗胫股骨膝骨关节炎的胫股骨支具、治疗膝关节骨关节炎的外用非甾体抗炎药 (NSAID)、口服 NSAID 和关节内糖皮质激素注射治疗膝骨关节炎。有条件的建议包括平衡练习、瑜伽、认知行为治疗、针对第一 CMC OA 的肌动贴、除第一 CMC 关节外的手关节矫形器、针对髌股膝 OA 的髌股支具、针对膝 OA 的针灸、热疗法、射频消融、局部 NSAIDs、针对手 OA 的关节内类固醇注射和硫酸软骨素、针对膝 OA 的局部辣椒素、对乙酰氨基酚、度洛西汀和曲马多。本指南为临床医生和患者制定 OA 治疗决策提供指导。临床医生和患者应共同决策，考虑患者的价值观、偏好和合并症。这些建议不应被用来限制或拒绝接受治疗。美国风湿病学会 (ACR) 制定和/或认可的指南和建议旨在为实践模式提供指导，而不是规定特定患者的护理。 ACR 认为遵守本指南中的建议是自愿的，其应用的最终决定将由临床医生根据每个患者的个人情况做出。指南和建议旨在促进有益或理想的结果，但不能保证任何具体结果。 ACR 制定和认可的指南和建议会根据医学知识、技术和实践的发展进行定期修订。 ACR 建议无意决定付款或保险决策。这些建议无法充分传达患者护理的所有不确定性和细微差别。美国风湿病学会是一个独立、专业的医学和科学协会，不保证、保证或认可任何商业产品或服务。
To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid Injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies. Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the clinician in light of each patient’s individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes, but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision, as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions. These recommendations cannot adequately convey all uncertainties and nuances of patient care. The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service.
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影响因子：
168.9
作者：
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通讯作者：
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Schenck R
影响因子：
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Murphy L;Schwartz TA;Helmick CG;Renner JB;Tudor G;Koch G;Dragomir A;Kalsbeek WD;Luta G;Jordan JM
通讯作者：
Jordan JM
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168.9
作者：
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通讯作者：
Trelle, Sven