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PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee
Oscar Rillo1, Humberto Riera, Carlota Acosta
1From the *Servicio de Reumatología del Hospital Ignacio Pirovano, Buenos Aires, Argentina; †Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela; ‡Complejo Hospitalario Universitario "Ruiz y Páez", Ciudad Bolívar, Venezuela; §Unidad de Investigación Reumatológica, Clínica Félix Boada, Caracas, Venezuela; ∥Hospital Pérez Carreño, Caracas, Venezuela; ¶Clínica Colinas, Anzoátegui, Venezuela; #Instituto Autónomo Hospital Universitario de Los Andes, Servicio de Traumatología, Universidad de Los Andes, Mérida, Venezuela; **Centro Clínico La Isabelica, Carabobo, Venezuela; ††Instituto Docente de Urología, Valencia, Venezuela; ‡‡LabMice, Universidad de Los Andes, Mérida, Venezuela; §§Departamento de Reumatología, ∥∥Instituto Nacional de Rehabilitación, Ciudad de México, México ; ¶¶Departamento de Medicina Interna, Servicio de Reumatología, Universidad Autónoma de Nuevo León, Nuevo León, México; ##Cátedra de Reumatología de la Facultad de Medicina de la Universidad de la Republica, Montevideo, Uruguay; ***Arthritis Clinical Research Unit at Medicarte, Medellin, Colombia; †††Grupo de Reumatólogos del Caribe, Barranquilla, Colombia; ‡‡‡Departamento de Reumatología, Universidad Católica de Chile, Santiago, Chile; §§§Servicio de Reumatología, Hospital Quirúrgico 10 de Octubre, Cerro, La Habana, Cuba; ∥∥∥Servicio de Reumatología, Hospital Hermanos Ameijeiras and Servicio de Reumatología del Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba; ¶¶¶Servicio de Reumatología Hospital Santa Cruz, Caja Petrolera de Salud Techo Académico Universidad Católica, San Pablo, Bolivia; ###Servicio de Reumatología Kolping y Hospital Alfonzo Gumucio-Techo Académico Universidad Católica, San Pablo, Bolivia; ****Post-Grado de Reumatología, AGAR, FM, UFM, Facultad de Medicina, Universidad Francisco Marroquín, Guatemala City, Guatemala; †††
Objective:
The objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America.
Methods:
Recommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique.
Results:
Both "strong" and "conditional" recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement.
Conclusions:
These recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.
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