The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of knee, hip and hand osteoarthritis

Abstract

Osteoarthritis (OA) is the most common musculoskeletal disease leading to functional decline and loss in quality of life. Knees, hands and hips are frequently affected joints with a relevant clinical and socio-economic burden. An evidence-based approach to OA management is essential in order to improve patients’ health and to decrease social burdens. Since new international clinical practice guidelines (CPGs) focused on diagnosis or pharmacological/non-pharmacological treatment have become available in the last ten years, the Italian Society for Rheumatology (SIR) was prompted to revise and customize them for a multidisciplinary audience of specialists involved in the management of OA. The framework of the Guidelines International Network Adaptation Working Group was adopted to identify, appraise (AGREE II), synthesize, and customize the existing CPGs on OA to the needs of the Italian healthcare context. The task force, consisting of rheumatologists from the SIR epidemiology research unit and a committee with experience of OA, identified key health questions to guide a systematic review of published guidelines. The target audience included physicians and health professionals who manage OA. An external panel of stakeholders rated the guidelines. From a systematic search in databases (Pubmed/Medline, Embase) and grey literature, 11 CPGs were selected and appraised by two independent raters. Combining evidence and statements from these CPGs and clinical expertise, 16 guidelines were developed and graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. These revised guidelines are intended to provide guidance for diagnosis and treatment of OA and to disseminate best evidence-based strategies management of the disease.

Effects of Protein Supplementation Combined with Exercise Training on Muscle Mass and Function in Older Adults with Lower-Extremity Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Trials

“…OA has been recognized as a major musculoskeletal disease [ 13 ]. The management of mild to moderate OA comprises multidisciplinary interventions, including pain medications and nonpharmacological treatments; however, for end-stage OA, total joint replacement is recommended [ 14 ]. Several recent studies have indicated physical activity and nutrition as nonpharmacological and preventive treatments for OA and sarcopenia [ 15 , 16 , 17 , 18 , 19 ].…”

Comparison of Short-Term Efficacy of Total Knee Arthroplasty Versus Arthroscopy in Chinese Patients with Knee Osteoarthritis

“…Total knee arthroplasty is the main treatment method for patients with knee joint disease who are ineffective after various conservative treatments. Among them, degenerative osteoarthrosis of the knee joint is the most common joint diseases [25]. After patients undergo total knee arthroplasty, joint pain can usually be signi cantly improved, and local deformities can be effectively corrected.…”

Economic burden of prescriptive inadequacy in the management of osteoarthritis in Italy

“…Costo COX-2 = ciclossigenasi-2; FANS = farmaci antinfiammatori non steroidei; OA = osteoartrite metà dei pazienti considerati sia sottoposta a un incremento della posologia/die iniziale. Dall'analisi così realizzata emerge come il costo di gestione appropriata di un paziente affetto da OA, indipendentemente dal sito colpito, considerando i costi delle Liste di trasparenza AIFA e delle alternative farmacologiche, le giornate medie di trattamento e le posologie indicate dal panel di clinici esperti sulla base delle Linee Guida nazionali e internazionali (10), risulta essere pari a €77,79. In particolare, il paracetamolo è il farmaco associato al costo di gestione più basso (€0,35), mentre i FANS sono le alternative associate all'assorbimento di risorse maggiore (€28,31).…”