EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

W Zhang, M Doherty, N Arden, B Bannwarth, J Bijlsma, K-P Gunther, H J Hauselmann, G Herrero-Beaumont, K Jordan, P Kaklamanis, B Leeb, M Lequesne, S Lohmander, B Mazieres, E Martin-Mola, K Pavelka, A Pendleton, L Punzi, B Swoboda, R Varatojo, G Verbruggen, I Zimmermann-Gorska, M Dougados, EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT), W Zhang, M Doherty, N Arden, B Bannwarth, J Bijlsma, K-P Gunther, H J Hauselmann, G Herrero-Beaumont, K Jordan, P Kaklamanis, B Leeb, M Lequesne, S Lohmander, B Mazieres, E Martin-Mola, K Pavelka, A Pendleton, L Punzi, B Swoboda, R Varatojo, G Verbruggen, I Zimmermann-Gorska, M Dougados, EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Abstract

Objective: To develop evidence based recommendations for the management of hip osteoarthritis (OA).

Methods: The multidisciplinary guideline development group comprised 18 rheumatologists, 4 orthopaedic surgeons, and 1 epidemiologist, representing 14 European countries. Each participant contributed up to 10 propositions describing key clinical aspects of hip OA management. Ten final recommendations were agreed using a Delphi consensus approach. Medline, Embase, CINAHL, Cochrane Library, and HTA reports were searched systematically to obtain research evidence for each proposition. Where possible, outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. Effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation was assessed using the traditional A-D grading scale and a visual analogue scale.

Results: Ten key treatment propositions were generated through three Delphi rounds. They included 21 interventions, such as paracetamol, NSAIDs, symptomatic slow acting disease modifying drugs, opioids, intra-articular steroids, non-pharmacological treatment, total hip replacement, osteotomy, and two general propositions. 461 studies were identified from the literature search for the proposed interventions of efficacy, side effects, and cost effectiveness. Research evidence supported 15 interventions in the treatment of hip OA. Evidence specific for the hip was strikingly lacking. Strength of recommendation varied according to category of research evidence and expert opinion.

Conclusion: Ten key recommendations for the treatment of hip OA were developed based on research evidence and expert consensus. The effectiveness and cost effectiveness of these recommendations were evaluated and the strength of recommendation was scored.

Figures

Figure 1
Figure 1
Interventions for hip osteoarthritis from the general literature search. SYSADOA, symptomatic slow acting drugs for OA; THR, total hip replacement.
Figure 2
Figure 2
Study designs for hip OA from the general literature search. EE, economic evaluation; SR, systematic review; RCT, randomised controlled trial; CT, controlled trial.

References

    1. Ann Rheum Dis. 1999 Apr;58(4):201-7
    1. Arthritis Rheum. 1999 Jul;42(7):1361-9
    1. World J Surg. 1999 Aug;23(8):789-93
    1. J Rheumatol. 2000 Jan;27(1):205-11
    1. Pain. 2000 Mar;85(1-2):169-82
    1. JAMA. 2000 Mar 15;283(11):1469-75
    1. J Rheumatol. 2000 Mar;27(3):764-71
    1. Cochrane Database Syst Rev. 2000;(2):CD000517
    1. J Bone Joint Surg Br. 2000 May;82(4):517-25
    1. Osteoarthritis Cartilage. 2000 Sep;8(5):335-42
    1. J Orthop Sci. 2000;5(4):336-41
    1. J Rheumatol. 2000 Sep;27(9):2203-14
    1. Ann Intern Med. 2000 Oct 17;133(8):635-46
    1. J Arthroplasty. 2003 Oct;18(7):872-8
    1. Clin Exp Rheumatol. 2003 Sep-Oct;21(5):605-10
    1. Ann Rheum Dis. 2003 Dec;62(12):1145-55
    1. J Rheumatol. 2004 Jan;31(1):150-6
    1. Clin Orthop Relat Res. 2004 Jan;(418):67-73
    1. Ann Rheum Dis. 2004 Aug;63(8):901-7
    1. Ann R Coll Surg Engl. 1988 May;70(3):156-7
    1. Epidemiol Rev. 1988;10:1-28
    1. Br J Clin Pharmacol. 1989 Feb;27(2):235-42
    1. Arzneimittelforschung. 1990 Mar;40(3):316-8
    1. J Bone Joint Surg Br. 1990 Jul;72(4):653-7
    1. Pain. 1990 Dec;43(3):309-18
    1. Ann Intern Med. 1991 Nov 15;115(10):787-96
    1. Stat Med. 1991 Nov;10(11):1665-77
    1. Clin Ter. 1991 Dec 15-31;139(5-6):179-89
    1. Arch Intern Med. 1992 Jun;152(6):1289-95
    1. Arthritis Rheum. 1993 Apr;36(4):447-59
    1. Clin Ther. 2001 Jul;23(7):1061-79
    1. Chir Organi Mov. 1999 Jul-Sep;84(3):257-61
    1. Dig Dis Sci. 2001 Sep;46(9):1924-36
    1. Circulation. 2001 Nov 6;104(19):2280-8
    1. Arthritis Rheum. 2001 Nov;44(11):2539-47
    1. BMJ. 2002 Sep 21;325(7365):619
    1. Rheumatology (Oxford). 2002 Oct;41(10):1155-62
    1. Arthritis Rheum. 2002 Nov;46(11):3046-54
    1. Clin Orthop Relat Res. 2002 Dec;(405):168-74
    1. J Orthop Sci. 2003;8(1):32-5
    1. Br J Gen Pract. 2003 Jan;53(486):26-30
    1. J Bone Joint Surg Am. 2003 Feb;85-A(2):266-72
    1. Value Health. 2003 Mar-Apr;6(2):144-57
    1. Cochrane Database Syst Rev. 2003;(2):CD004257
    1. Arch Phys Med Rehabil. 2003 Aug;84(8):1224-6
    1. Cochrane Database Syst Rev. 2003;(3):CD004286
    1. Disabil Rehabil. 2003 Jul 22;25(14):771-7
    1. Clin Orthop Relat Res. 2003 Sep;(414):112-20
    1. Ann Rheum Dis. 2003 Oct;62(10):923-30
    1. Arthritis Rheum. 1995 Nov;38(11):1535-40
    1. Rev Rhum Engl Ed. 1995 Oct;62(9):563-70
    1. JAMA. 1996 Mar 20;275(11):858-65
    1. BMJ. 1996 May 11;312(7040):1215-8
    1. Am J Kidney Dis. 1996 Jul;28(1):14-22
    1. BMJ. 1996 Aug 10;313(7053):321-5
    1. Am J Epidemiol. 1993 May 15;137(10):1081-8
    1. Clin Orthop Relat Res. 1994 Jan;(298):156-64
    1. Acta Orthop Scand. 1994 Feb;65(1):9-11
    1. Ann Intern Med. 1994 Jul 15;121(2):133-40
    1. BMJ. 1995 Feb 18;310(6977):452-4
    1. Pharmacoeconomics. 1998 Jan;13(1 Pt 2):135-46
    1. Rev Rhum Engl Ed. 1997 Dec;64(12):825-34
    1. J Clin Pharmacol. 1998 Feb;38(2 Suppl):19S-24S
    1. Arthritis Rheum. 1998 May;41(5):778-99
    1. BMJ. 2000 Nov 11;321(7270):1179-83
    1. Ann Rheum Dis. 2000 Dec;59(12):936-44
    1. Ann Rheum Dis. 2001 Mar;60(3):228-32
    1. J Arthroplasty. 2001 Jan;16(1):87-91
    1. Cochrane Database Syst Rev. 2001;(1):CD002946
    1. Cochrane Database Syst Rev. 2001;(1):CD002947
    1. Ann Chir Gynaecol. 2001;90(1):28-31
    1. JAMA. 2001 Jul 18;286(3):315-21
    1. Rheumatology (Oxford). 2001 Jul;40(7):779-93
    1. J Orthop Sci. 2001;6(2):137-40
    1. Epidemiology. 2001 Sep;12(5):570-6
    1. J Bone Joint Surg Br. 2001 Nov;83(8):1119-24
    1. N Engl J Med. 2001 Dec 20;345(25):1801-8
    1. Drug Saf. 2001;24(15):1127-42
    1. J Rheumatol. 2002 Feb;29(2):347-52
    1. Arthritis Rheum. 2002 Feb;46(2):328-46
    1. J Bone Joint Surg Am. 2002 Mar;84-A(3):404-10
    1. Arthritis Rheum. 2002 Feb;47(1):50-8
    1. J Rheumatol. 2002 Apr;29(4):804-12
    1. Ir Med J. 2002 Jun;95(6):177-80
    1. J Rheumatol. 2002 Aug;29(8):1737-45
    1. Joint Bone Spine. 2002 Jun;69(4):388-91
    1. Br J Clin Pharmacol. 2002 Sep;54(3):320-6
    1. JAMA. 1996 Aug 28;276(8):637-9
    1. Arthritis Care Res. 1996 Aug;9(4):292-301
    1. Ann Rheum Dis. 1997 Aug;56(8):476-80
    1. Arthritis Rheum. 1998 Jan;41(1):81-91
    1. Rheumatology (Oxford). 2002 Feb;41(2):142-7
    1. J Rheumatol Suppl. 1998 May;51:31-41
    1. Am J Gastroenterol. 1998 Jul;93(7):1051-4
    1. Health Technol Assess. 1998;2(6):1-133
    1. BMJ. 1998 Nov 7;317(7168):1309-12
    1. BMJ. 1999 Feb 27;318(7183):593-6
    1. Health Technol Assess. 1998;2(20):1-64
    1. J Rheumatol. 1999 Apr;26(4):855-61

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe