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EULAR -OA of the Knee
These recommendations were developed using both an Evidence-Based Medicine (EBM) and Expert Opinion Approach. The committee task force had representative from thirteen European countries and included experts in guideline methodology and in OA research and management. They focused on 23 different treatment modalities. An extensive literature review was conducted on each modality. Each was evaluated based on a series of questionnaires.
Evidence-Based Medicine Approach
Expert's Opinion Approach
European League Against Rheumatism (EULAR) Recommendations: The Evidence-Based Medicine (EBM) Approach. B Leeb, A Hauselman, CH.

During an oral presentation, Dr. Leeb reviewed the EULAR Recommendations for the Medical Management of Knee Osteoarthritis (OA) using an EBM approach. These recommendations, pending final revisions, are due to be submitted for publication in July 2000. 23 intervention modalities were reviewed based on an extensive literature search using publications through 1998.

Based on the extensive review of information to date, three propositions have been formulated.

  1. Knee aspiration and intra-articular injection of steroids are indicated in case of acute painful hydarthrodia episode.
  2. 2. Exercises, specifically those directed to increase strength of quadriceps and or preserve normal mobility of the knee, are strongly recommended.
  3. 3. Paracetamol is the oral analgesic to try first and, if successful, is the preferred long-term oral analgesic.

Editorial Comments: These recommendations are largely in agreement with those of the American College of Rheumatology recommendations.

EULAR Recommendations: Experts Opinion Approach. M Dougados, F.

In addition to the recommendations cited in Hochberg and Leeb et al, Dr. Dougados discussed EULAR Recommendations for the Medical Management of Knee OA that are based on a survey of experts. Again, 23 treatment modalities were evaluated and ranked by experts on a scale of 0-100 ranging from whether they strongly recommend this treatment or do not recommend it at all. The modalities were ranked using several characteristics, i.e. primary choice, fast acting, localization of joint, type of symptoms, patient characteristics.

A total of ten recommendations were suggested, some of which are summarized below.

  • Therapy should be individualized for the patient.
  • Treatment should involve a combination of pharmacologic and non-pharmacologic therapy.
  • Paracetamol should be used as first line treatment.
  • When unresponsive to paracetamol, NSAIDs are recommended.
  • Knee aspirations and intra-articular injection should be considered for acute pain.
Evaluation by other health care providers is the next step.

Editorial Comment: One question raised was what framework would be employed in order to test these guidelines. While clearly acknowledging that this is an important necessity, no clear method was proposed.

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