EULAR recommendations for the management of knee osteoarthritis: report ofa task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

Background-Osteoarthritis (OA) is the most common joint disease encountered throughout Europe. A task force for the EULAR Standing Committee for Clini cal Trials met in 1998 to determine the methodological and logistical appro ach required for the development of evidence based guidelines for treatment of knee OA. The guidelines were restricted to cover all currently availabl e treatments for knee OA diagnosed either clinically and/or radiographicall y affecting any compartment of the knee. Methods-The first stage was the selection of treatment modalities to be con sidered. The second stage comprised a search of the electronic databases Me dline and Embase using a combination of subject headings and keywords. All European language publications in the form of systematic reviews, meta-anal yses, randomised controlled trials, controlled trials, and observational st udies were included. During stage three all the relevant studies were quali ty scored. The summary statistics for validated outcome measures, when avai lable, were recorded and, where practical, the numbers needed to treat and the effect size for each treatment were calculated. In the fourth stage key clinical propositions were determined by expert consensus employing a Delp hi approach. The final stage ranked these propositions according to the ava ilable evidence. A second set of propositions relating to a future research agenda was determined by expert consensus using a Delphi approach. Results-Over 2400 English language publications and 400 non-English languag e publications were identified. Seven hundred and forty four studies presen ted outcome data of the effects of specific treatments on knee OA. Quantita tive analysis of treatment effect was possible in only 61 studies. Recommen dations for the management of knee OA based on currently available data and expert opinion are presented. Proposals for a future research agenda are h ighlighted. Conclusions-These are the first clinical guidelines on knee OA to combine a n evidence based approach and a consensus approach across a wide range of t reatment modalities. It is apparent that certain clinical propositions are supported by substantial research based evidence, while others are not. The re is thus an urgent need for future well designed trials to consider key c linical questions.