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Cited by 2,796Osteoarthritis Treatment and MechanismsClinical practice guidelines implementationMusculoskeletal pain and rehabilitation

OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines

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Zhang, W., Moskowitz, R.W., Nuki, G., Abramson, S., Altman, R.D., Arden, N., Bierma-Zeinstra, S., Brandt, K.D. +8 more·2008·Osteoarthritis and Cartilage
DOI 10.1016/j.joca.2007.12.013
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Abstract

PURPOSE: To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. METHODS: Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. RESULTS: Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. CONCLUSION: Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.

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  • Capsaicin gel and S-adenosyl methionine were effective in the management of osteoarthritis.

    “There was proven evidence that capsaicin gel and S-adenosyl methionine were effective in the management of osteoarthritis [64] , Indian Frankincense, methyl sulphonyl methane and rose hip may also be effective.”

    From Alternative Medicine: New Ways to Treat Diseases and Therapies (2021) · cites this paper as [64]

    Section 14 says topical capsaicin can be effective for knee osteoarthritis and cites evidence for a capsaicin cream, not specifically a gel. The passages found do not address S-adenosyl methionine (searched that name and SAMe), so the source supports only the capsaicin part of the attributed claim. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Indian Frankincense, methyl sulphonyl methane and rose hip may also be effective in the management of osteoarthritis.

    “There was proven evidence that capsaicin gel and S-adenosyl methionine were effective in the management of osteoarthritis [64] , Indian Frankincense, methyl sulphonyl methane and rose hip may also be effective.”

    From Alternative Medicine: New Ways to Treat Diseases and Therapies (2021) · cites this paper as [64]

    The General recommendations discuss topical capsaicin and glucosamine/chondroitin, but do not address the effectiveness of Indian frankincense, methyl sulphonyl methane, or rose hip. Searches of our full-text copy for those names and their variants found no passage assessing them. In the citing sentence, [64] also appears before the three-supplement claim. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

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Authors
Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D. J., Kwoh, K., Lohmander, L. S., & Tugwell, P.
Affiliations
The Queen's Medical Research Institute (GB)
Corresponding author
Nuki, G.
ORCID
Venue
Osteoarthritis and Cartilage
Publisher
Elsevier BV
Published
2008-02
Volume
16
Issue
2
Pages
137-162
ISSN
1063-4584 (ISSN-L)
DOI
10.1016/j.joca.2007.12.013
OpenAlex
W2167792025
Cited by
2,796
References
10
Citations by year
2026: 47 · 2025: 71 · 2024: 70 · 2023: 94 · 2022: 124 · 2021: 177 · 2020: 146 · 2019: 143 · 2018: 152 · 2017: 143 · 2016: 174 · 2015: 178 · 2014: 245 · 2013: 241 · 2012: 213
FWCI
132.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Osteoarthritis and Cartilage (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
hip osteoarthritis, knee osteoarthritis, osteoarthritis management, non-pharmacological treatment, pharmacotherapy, analgesia, self-management education, physiotherapy, exercise therapy, weight loss, analgesics, intra-articular injection, osteoarthritis surgery, telephone follow-up, resistance training, aquatic exercise, strength of recommendation
MeSH terms
Humans, Osteoarthritis, Hip, Practice Guidelines as Topic, Evidence-Based Medicine, Osteoarthritis, Knee, Consensus

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