EULAR recommendations for intra-articular therapies

Abstract

ObjectivesTo establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.MethodsA multidisciplinary international task force established the objectives, users and scope and the need for background information, including systematic literature reviews) and two surveys addressed to healthcare providers and patients throughout Europe. The evidence was discussed in a face-to-face meeting, recommendations were formulated and subsequently voted for anonymously in a three-round Delphi process to obtain the final agreement. The level of evidence was assigned to each recommendation with the Oxford levels of evidence.ResultsRecommendations focus on practical aspects to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles and 11 recommendations were established, addressing issues related to patient information, procedure and setting, accuracy, routine and special aseptic care, safety issues and precautions to be addressed in special populations, efficacy and safety of repeated joint injections, use of local anaesthetics and aftercare.ConclusionWe have developed the first evidence and expert opinion-based recommendations to guide health professionals using IAT. We hope that these recommendations will be included in different educational programmes, used by patient associations and put into practice via scientific societies to help improve uniformity and quality of care when performing IAT in peripheral adult joints.

Intra-articular therapies: patient preferences and professional practices in European countries

“…Under the auspices of the European Alliance of Associations of Rheumatology (EULAR), an international panel of experienced rheumatologists, an orthopaedic surgeon, a radiologist, a rheumatology nurse, a nuclear medicine specialist, and a patient research partner (PRP) was established. The task force aimed to establish evidence-based recommendations for the use of IATs in people with RMDs [10]. Panel discussions led to suggest the need to know how patients experience IATs, how these are performed, whether anaesthetics are used, which compounds are injected, for what indications and with what aids, etc.…”

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs)

“…The present PtC nevertheless represent a step forward in the approach to conduct interventional procedures using imaging, complementing recent EULAR recommendations for intra-articular therapies. 1 We believe that their implementation will improve patient care.…”

“…Studies comparing different measures to guarantee the sterility of imaging guided interventional procedures are absent, and 1 The suggestions in box 1 are not intended to cover every clinical situation nor to reflect all national guidelines. Some authorities for example, recommend using sterile gel for US guided interventions which is not current practice in every EULAR country.…”

“…Interventional procedures such as fluid aspiration, injections and biopsies are conducted for diagnostic and therapeutic purposes in patients with different rheumatic and musculoskeletal diseases (RMDs). 1 Real-time visualisation of the needle or instruments by ultrasound (US), CT, MRI or fluoroscopy has the potential to ensure reliable placement of the needle tip/instrument in the respective anatomical area and to monitor the success of various interventions such as synovial fluid aspiration, drug injection and/or tissue biopsy. [2][3][4][5][6] Imaging guided procedures, however, are also more resource consuming than conventional palpation guided interventions, require additional preparation and training, and there are some studies suggesting that the outcomes of palpation and imaging guided interventions are not meaningfully different.…”

Improvement in condition specific and generic quality of life outcomes in patients with knee osteoarthritis following single intraarticular viscosupplementation injection

“…1 When it comes to the effectiveness of intra-articular injections of Hyaluronic acid in OA knee, several study trials have been done, but the results have been variable. 6…”