Evaluation of Clinical Practice Guidelines for Knee Osteoarthritis

Clinical practice guidelines are an important decision making tool for physicians. A recent study published in Seminars in Arthritis and Rheumatism demonstrated the importance of having these guidelines for the treatment of knee osteoarthritis. Researchers concluded the “appropriate methodology” for knee osteoarthritis patients is necessary, specifically in regards to the use of intra-articular hyaluronic acid.

Intra-articular hyaluronic acid treatment works to restore the normal viscoelasticity of synovial fluid in patients with osteoarthritis. Researchers reviewed recommendations of clinical practice guidelines for the use of intra-articular hyaluronic acid in knee osteoarthritis patients. They utilized the AGREE II instrument to help assess the methodological quality of the guidelines.

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The study identified 10 clinical practice guidelines that met the researchers’ inclusion criteria. The methodology utilized for the evidence regarding inclusion criteria, analysis of evidence results, formulation of clinical practice recommendations, and work group composition for the study was heterogeneous. Variability in guideline methodology caused the treatment recommendations for osteoarthritis to be highly inconsistent. Of the 10 clinical practice guidelines, 30% recommended intra-articular hyaluronic acid in situations when this treatment method is necessary. 30% advised against using intra-articular hyaluronic acid, and 40% of guidelines were uncertain on the use of intra-articular hyaluronic acid or had no recommendation on the treatment due to the increased variability regarding trial efficacy and quality.

The researchers concluded that a standard “appropriate methodology” for osteoarthritis clinical practice guidelines is needed. Inconsistency among its guidelines has created confusion around the use of intra-articular hyaluronic acid as a treatment option for knee osteoarthritis. Standardizing guidelines will prohibit inconsistent recommendations regarding intra-articular hyaluronic acid among physicians treating knee osteoarthritis.—Jordyn Greenblatt

Reference

Altman RD, Schemitsch E, Bedi A. Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid. Seminars in Arthritis and Rheumatism. 2015 May 7. [Epub ahead of print].