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Abstract Number: 1497

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

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Session Information

Date: Monday, November 9, 2015

Session 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 April 17, 2021.
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