Concerns over the cardiovascular safety of non-steroidal anti-inflammatory drugs (NSAIDs) led to the publication of several sets of fresh guidelines on the treatment of knee osteoarthritis. But a review of these guidelines found many differences in treatments addressed and a lack of educational information in most of the articles.
An international team of 13 clinical researchers, including rheumatologists, physiotherapists, occupational health experts and general practitioners, scrutinized six sets of knee osteoarthritis treatment guidelines, which were published or updated between 2001 and 2006. Evaluators were trained on how to apply the AGREE criteria* to evaluate the guidelines.
Guidelines recommend acetaminophen for initial pain treatment, combined with exercise and education. If acetaminophen fails to control pain, NSAIDs are the next option, but should be used cautiously because of gastro-intestinal (GI) risks. The guidelines indicate surgery for persistent pain and disability. Most guidelines address education and activity management interventions superficially, and the team suggests that these should be detailed in the future.
The guideline effectively addressed only a minority of AGREE domains. "To improve applicability and increase uptake by end users, stakeholder opinions and barriers in use need to be taken into account during guideline development," the authors say. Guideline development and the spreading of new knowledge are slow processes, and the authors also recommend development of innovative knowledge translation methods to health professionals.
Knee osteoarthritis causes significant costs and disability in the population, and is increasingly prevalent due to higher obesity rates and an aging population.
*A review of the quality of knee osteoarthritis guidelines using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument was published in 2002, and concluded that the quality of the guidelines varied and could generally be improved.
Journal reference: Stéphane Poitras; Jérôme Avouac; Michel Rossignol; Bernard Avouac; Christine Cedraschi; Margareta Nordin; Chantal Rousseaux; Sylvie Rozenberg; Bernard Savarieau; Philippe Thoumie; Jean-Pierre Valat; Éric Vignon; Pascal Hilliquin. A critical appraisal of guidelines for the management of knee osteoarthritis using AGREE criteria. Arthritis Research & Therapy (in press) (http://arthritis-research.com/)
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