Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism

Abstract

Amaç: Diz osteoartriti (OA) sık görülen ve neden olduğu ağrı ve sakatlık sonucunda sosyoekonomik yük bindiren bir hastalıktır. Türkiye Romatizma Araştırma ve Savaş Derneği (TRASD) OA tedavisi ile uğraşan hekimlere günlük klinik uygulamalarında yardımcı olmak amacıyla, uzman görüşleri ile desteklenmiş, ulusal "diz osteoartrit tedavisinde kanıta dayalı önerileri" hazırlamak için bir proje başlatmıştır. Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, "evidence-based recommendations for the management of knee osteoarthritis" supported by expertopinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Gereç ve yöntemler: Materials and methods:The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the "strength of recommendation" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting.Results: Nineteen propositions (one for general principles, nine for nonpharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the "TLAR Evidence-Based Recommendations for the Management of Knee OA" in consensus as a result of Delphi rounds. Conclusion:Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.

Impact of Polypharmacy on Functional State in Patients with Symptomatic Knee Osteoarthritis

“…Acetaminophen is suggested as the first option in many OA treatment guides. In cases where paracetamol is ineffective for symptomatic knee OA, NSAII use is listed in almost all suggestions or guides [17]. As the primary complaint by most of the patients with OA is pain, ratio of the patients using NSAII and paracetamol, which are frequently used for pain, was identified to be 86% and 66%, respectively.…”

The effect of self‐administered superficial local hot and cold application methods on pain, functional status and quality of life in primary knee osteoarthritis patients

“…It has been reported in various treatment guides developed in accordance with evidence‐based procedures that superficial local hot applications may have beneficial effects on pain and functional status in selected patients without active synovitis while superficial local cold application may be recommended in the presence of synovitis. It is also stated that hot and cold applications can decrease the pain in knee osteoarthritis and improve physical function (Tuncer et al., ; Zhang et al., ). Brosseau et al.…”

“…status in selected patients without active synovitis while superficial local cold application may be recommended in the presence of synovitis. It is also stated that hot and cold applications can decrease the pain in knee osteoarthritis and improve physical function (Tuncer et al, 2012;Zhang et al, 2008). Brosseau et al (2003) reported in their review that cold applications provide significant benefits regarding the range of motion in the knee joint and the function and muscle strength in individuals with knee osteoarthritis, but has no significant effect on the pain.…”

Rehabilitative Approach to Rheumatological Diseases

“…Last year, the Turkish League Against Rheumatism (TLAR) provided recommendations for the management of osteoarthritis (OA), RA, and ankylosing spondylitis (AS) by taking into consideration the health care system of our country. [6][7][8] These recommendations emphasized the importance of non-pharmacological interventions. The rehabilitative treatment approach included educational programs (lifestyle alterations, weight control, joint protection, and energy consumption), physical therapy modalities [thermotherapy, cryotherapy, electrotherapy, transcutaneous electrical nerve stimulation (TENS), and laser therapy], exercise (range of motion, strengthening, stretching, flexibility, muscle conditioning, aerobics, and cardiopulmonary fitness), ergonomic arrangements, assistive and adaptive devices, protective and corrective orthoses, appropriate footwear, and hydrotherapy (balneotherapy, spa, and aquatherapy).…”