Date: Monday, November 9, 2015
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).
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.
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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