Toupin-april K, Hochberg M, Tugwell P, et al.

Development of the 2009 revised ACR recommendations for the management of osteoarthritis 2010 Annual Meeting of the Canadian Rheumatology Association (CRA) (Quebec; Canada: Feb ua y !" 2010) Objective: To develop revised reco endations !or the anage ent o! osteoarthritis o! the hand, hip and "nee. Methods: # list o! phar acological and non-phar acological odalities co onl$ used to anage osteoarthritis %O#) o! the "nee, hip and hand as well as clinical scenarios were generated b$ a tea o! e&perts. # s$ste atic review o! the literature was underta"en to identi!$ current scienti!ic evidence concerning the bene!its and har s !or each odalit$. The search was conducted in M'()*+' %,-./-0//-), 'M1#2' %,-3/-0//-) and The 4ochrane )ibrar$ %*ssue 5, 0//-). The 6ualit$ o! the evidence was appraised using the 78#(' %7rading o! 8eco endations #ssess ent, (evelop ent and 'valuation) s$ste and the evidence was su ari9ed into the 78#(' 2u ar$ o! :indings table and 'vidence pro!ile. # panel o! ,; clinical e&perts in pri ar$ care, rheu atolog$, orthopedics, rehabilitation and geriatrics was gathered to review the evidence and develop reco endations using the 78#(' s$ste . 8esults: 8eco endations covered the use o! 0- odalities. Modalities suggested !or the anage ent o! hand O# were oral non-steroidal anti-in!la ator$ drugs %+2#*(s), tra adol, topical +2#*(s, capsaicin, trola ine salic$late, joint protection techni6ues, assistive devices, use o! ther al agents and splints. Modalities reco ended !or the anage ent o! "nee O# were landand water-based e&ercises as well as weight loss !or overweight patients. Other phar acological and non-phar acological odalities were also suggested !or "nee O# such as: aceta inophen, oral and topical +2#*(s, tra adol, intraarticular injections, edial wedge insoles !or valgus "nee O#, subtalar strapped lateral insoles !or varus "nee O#, ediall$-directed patellar taping, anual therap$, acupuncture, transcutaneous electrical nerve sti ulation %T'+2), wal"ing aids, ther al agents and ps$chosocial interventions. 2eparate reco endations could not be ade !or hip O# because o! li ited scienti!ic evidence 4onclusion: The 0//- revised # erican 4ollege o! 8heu atolog$ %#48) reco endations !or the anage ent o! O# were developed b$ a panel o! e&perts using the 78#(' ethod. 8eco endations covered the use o! 0- odalities, including both phar acological and non-phar acological odalities. <se o! this ethod as well as clinical scenarios is an innovative strength o! the present reco endations. #uthor #!!iliation: *nstitute o! Population Health, <niversit$ o! Otta, Ottawa, <niversit$ o! Ottawa, Ottawa and The #rthritis 2ociet$, Ottawa