OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis
OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis
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DOI：
10.1016/j.joca.2019.06.011
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发表时间：
2019-11-01
影响因子：
7
通讯作者：
McAlindon, T. E.
中科院分区：
文献类型：
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作者：
Bannuru, R. R.;Osani, M. C.;McAlindon, T. E.
目的：为了更新和扩展之前的国际骨关节炎研究协会（OARSI）的指导方针，通过制定以患者为中心的治疗建议，为个人与膝关节，髋关节和多关节骨关节炎（OA），来自专家共识，并基于高质量的荟萃分析data.Methods的客观审查：我们寻求证据60独特的干预措施。从一开始到2018年7月，对所有相关数据库进行了系统检索。经过两位独立评审员的摘要和全文筛选后，合格的研究与皮科问题匹配。使用RevMan软件提取数据并进行荟萃分析。使用GRADEpro网络应用程序编制建议评估、开发和评价分级（GRADE）证据概况。首先进行核心治疗的投票。随后通过匿名在线调查进行了四次投票，在此期间，小组成员的任务是投票，为所有联合地点和科摩罗类别提出建议。我们指定的非核心治疗水平1A，1B，2，3，4A，4 B，或5，赞成票的百分比的基础上，除了强度的recommendation.Results：核心治疗膝关节骨性关节炎包括关节炎教育和结构化的土地为基础的锻炼计划，或没有饮食体重管理。髋关节和多关节OA的核心治疗包括关节炎教育和结构化的陆上运动计划。强烈建议膝关节OA（1A级）患者使用局部非甾体类抗炎药（NSAID）。对于胃肠道合并症患者，考克斯-2抑制剂为1B级，NSAID与质子泵抑制剂为2级。对于患有心血管合并症或虚弱的个体，不建议使用任何口服NSAID。关节内（IA）皮质类固醇、IA透明质酸和水上运动是膝关节OA的1B级/2级治疗，取决于合并症状态，但不推荐用于髋关节或多关节OA患者。有条件地不推荐使用对乙酰氨基酚/扑热息痛（APAP）（4A和4 B级），强烈不推荐使用口服和透皮阿片类药物（5级）。构建了一个治疗算法，以指导临床决策的各种患者配置文件，使用推荐的治疗作为输入每个decision node.Conclusion：这些指南提供了全面的和以患者为中心的治疗个人与膝关节，髋关节和多关节OA的配置文件。该治疗算法将促进关于OA管理的个体化治疗决策。(C)2019国际骨关节炎研究学会。由爱思唯尔有限公司出版。保留所有权利。
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.