Panlar Consensus on Hand, Hip and Knee OA

Oscar Luis Rillo¹, Humberto Riera², Rolando Espinosa-Morales³, Carlota Acosta⁴, Veronica Liendo⁵, Joyce Bolaños⁶, Ligia Monterola⁷, Edgar Nieto⁸, Luisa M. Franco⁹, Rodolfo Arape¹⁰, Ana Antunez¹¹, Silvia Beatriz Papasidero¹², Mariflor Vera¹³, Jorge Esquivel¹⁴, Renee Souto¹⁵, Jose F. Molina¹⁶, César Rossi¹⁷, Francisco Ballesteros¹⁸, José Salas¹⁹, Francisco Radrigan²⁰, Marlene Guibert-Toledano²¹, Gil Reyes Llerena²², Lorena Urioste²³, Walter Camacho²⁴, Abraham García²⁵, Isa Iraheta²⁶, Carmen E Gutierrez²⁷, Raúl Aragón²⁸, Margarita Duarte²⁹, Oswaldo Castañeda³⁰, Juan Angulo Solimano³¹, Ibsen Coimbra³², Roberto Munoz Louis³³, Carlos Vallejo³⁴, Ricardo Saenz³⁵, Francisco Giron³⁶, Anibal De León³⁷, Ramon Perez Acuna³⁸, Anthony M. Reginato³⁹ and Maritza Quintero², ¹Hospital General de Agudos “Dr. Ignacio Pirovano”, Buenos Aires, Argentina, ²Unidad de Reumatología, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela, ³Mexican Board of Rheumatology, Mexico City, Mexico, ⁴Ciudad Bolivar, Hospital Universitario "Ruiz y Páez, Bolivar, Venezuela, ⁵Clínica Roosevelt, Caracas, Venezuela, ⁶Hospital Perez Carreño, Caracas, Venezuela, ⁷Clínica Colinas, Anzoátegui, Venezuela, ⁸Traumatology, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela, ⁹Instituto Docente de Urología, Carabobo, Venezuela, ¹⁰Centro Clínico La Isabelica, Carabobo, Venezuela, ¹¹Hospital Central Dr. URQUINAONA, Maracaibo, Venezuela, ¹²Rheumatology Department, Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina, ¹³Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela, ¹⁴Universidad Autónoma de Nuevo León, Distrito Federal, Mexico, ¹⁵Catedra de Reumatología de la Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay, ¹⁶Centro Integral de Reumatologia Reumalab, Medellin, Colombia, ¹⁷Cátedra de Reumatología de la Facultad de Medicina, Universidad de la República, Montevideo, Uruguay, ¹⁸Departamento de Reumatología, Universidad de Chile, Santiago, Chile, ¹⁹Reumacaribe, Barranquilla, Colombia, ²⁰Departamento de Reumatología, Universidad Católica de Chile, Santiago, Chile, ²¹Rheumatology, Centro de Investigaciones Médico Quirúrgicas, Habana, Ciudad Habana, Cuba, ²²Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba, ²³Hospital Alfonzo Gumucio-Techo Académico Universidad Católica, San Pablo, Bolivia, ²⁴Servicio de Medicina Interna, Hospital Obrero N° 3 de la Caja Nacional de Salud, Santa Cruz, Bolivia, ²⁵Postgrado de Reumatología, Universidad Francisco Marroquí, Guatemala, Guatemala, ²⁶Rheumatology, Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala, ²⁷Instituto Salvadoreño del Seguro Social, San Miguel, El Salvador, ²⁸FACULTAD DE MEDICINA, UNIVERSIDAD DE EL SALVADOR., San Salvador, El Salvador, ²⁹Servicio de Reumatología, Hospital de Clínicas de Asunción, Universidad Nacional de Asunción, Asunción, Paraguay, ³⁰Clínica Angloamericana, Lima, Peru, ³¹Rheumatology, Universidad Nacional Mayor San Marcos, Lima, Peru, ³²Departamento de Clínica Médica, Faculdade de Ciências Médicas da UNICAMP, Campinas, Brazil, ³³Reumatologia, Clinica Abreu - Hospital Docente Padre Billini, Santo Domingo, Dominican Republic, ³⁴FACULTAD DE MEDICINA. PONTIFICIA UNIVERSIDAD CATOLICA DEL ECUADOR., Quito, Ecuador, ³⁵Hospital Dr. Rafael A. Calderón Guardia, San José, Costa Rica, ³⁶IHSS Tegucigalpa, Tegucigalpa, Honduras, ³⁷Hospital Santo Tomás, Panama, Panama, ³⁸Zona franca ultrpark 6A, Zona franca ultrpark 6A, La Aurora de Heredia, Costa Rica, ³⁹Rheumatology, Rhode Island Hospital, The Warren Alpert School of Medicine at Brown University, Providence, RI

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Hand function, Hip, Knee, OA and guidelines

Session Information

Date: Monday, November 9, 2015

Title: Quality Measures and Quality of Care Poster Session (ARHP): Clinical Practice/Patient Care

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The purpose of this Consensus is to update the PANLAR recommendations for hand, hip and knee osteoarthritis (OA) based on a combination of the available evidence and expert opinion.

Methods: Recommendations were developed by a group of 40 specialists of 18 countries of Latin America, and patients suffering from OA of the referred joints. A systematic review of articles, meta-analysis and guidelines published between 2008 and January 2014 was undertaken. The level of evidence and degree of recommendation were classified according to the Center for Evidence Based Medicine at Oxford or Jadad scale. Level of agreement was established through a Delphi technique.

Results: Both “strong” and “conditional” recommendations were made. In hand OA it is important to educate regarding joint protection and to provide an exercise regimen that improves muscle strengthening and range of motion (IC). Topical NSAIDs are indicated in mild to moderate pain (IA). Acetaminophen (up to 3 g/day) is recommended as the oral analgesic of first choice (IA). If it is not effective, oral NSAIDs are recommended at the lowest effective dose and for the shortest time possible (IA). The use of chondroitin sulfate is recommended and may be used in the long-term (IA). The use of steroids or intra-articular hyaluronic acid might be considered for OA of the symptomatic TMC joint (IIaB). Surgery could be considered for severe rhizarthrosis in patients with strong pain and/or disability and after conservative treatment has failed (IIBB). For Hip OA, patients should be educated on the importance of changes in lifestyle (IB). Strengthening the extensors and abductors improves function and can prepare the patient before a hip implant (IB). In mild to moderate pain, acetaminophen (IB) is recommended. In cases of higher pain, high doses of NSAIDs or selective COX2 inhibitors could be indicated (IB). In patients who do not respond to NSAIDs or inhibitors of COX-2, or do not tolerate them or are contraindicated, weak opioids such as tramadol would be useful (IIbB). Total hip arthroplasty is indicated in patients with high pain, walking difficulty and loss of quality of life (IA). Finally in Knee OA, it is important to educate about lifestyle changes (IA). Acetaminophen is recommended up to 3 gr per day for mild pain (IA). For moderate pain, traditional and selective NSAIDs are indicated (IA). Topical NSAIDs may be indicated in patients with gastrointestinal risk (IA). In severe pain, the use of tramadol is recommended (IA).Treatment with chondroitin sulphate has demonstrated symptomatic effect in patients with knee OA and it may delay OA progression (IA). Combined use of glucosamine and chondroitin sulfate is indicated in patients with moderate to severe pain (IB). Benefits of intra-articular hyaluronic acid have been reported (IIaB). Arthroscopy is not beneficial (IIIA).Total knee arthroplasty may be indicated in knee OA (IIaB).

Conclusion:

These recommendations are based on the consensus judgment of clinical experts, informed by available evidence, balancing the benefits and harms of treatments, and incorporating their preferences and values. It is hoped that these recommendations will be useful in the management of OA patients.

Disclosure: O. L. Rillo, None; H. Riera, None; R. Espinosa-Morales, None; C. Acosta, None; V. Liendo, None; J. Bolaños, None; L. Monterola, None; E. Nieto, None; L. M. Franco, None; R. Arape, None; A. Antunez, None; S. B. Papasidero, None; M. Vera, None; J. Esquivel, None; R. Souto, None; J. F. Molina, None; C. Rossi, None; F. Ballesteros, None; J. Salas, None; F. Radrigan, None; M. Guibert-Toledano, None; G. Reyes Llerena, None; L. Urioste, None; W. Camacho, None; A. García, None; I. Iraheta, None; C. E. Gutierrez, None; R. Aragón, None; M. Duarte, None; O. Castañeda, None; J. Angulo Solimano, None; I. Coimbra, None; R. Munoz Louis, None; C. Vallejo, None; R. Saenz, None; F. Giron, None; A. De León, None; R. Perez Acuna, None; A. M. Reginato, None; M. Quintero, None.

To cite this abstract in AMA style:

Rillo OL, Riera H, Espinosa-Morales R, Acosta C, Liendo V, Bolaños J, Monterola L, Nieto E, Franco LM, Arape R, Antunez A, Papasidero SB, Vera M, Esquivel J, Souto R, Molina JF, Rossi C, Ballesteros F, Salas J, Radrigan F, Guibert-Toledano M, Reyes Llerena G, Urioste L, Camacho W, García A, Iraheta I, Gutierrez CE, Aragón R, Duarte M, Castañeda O, Angulo Solimano J, Coimbra I, Munoz Louis R, Vallejo C, Saenz R, Giron F, De León A, Perez Acuna R, Reginato AM, Quintero M. Panlar Consensus on Hand, Hip and Knee OA [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/panlar-consensus-on-hand-hip-and-knee-oa/. Accessed .

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