Zhang W, Doherty M, Leeb B F, Alekseeva L, Arden N K, Bijlsma J W, Dinçer F, Dziedzic K, Häuselmann H J, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I
Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.
Ann Rheum Dis. 2007 Mar;66(3):377-88. doi: 10.1136/ard.2006.062091. Epub 2006 Oct 17.
To develop evidence based recommendations for the management of hand osteoarthritis (OA).
The multidisciplinary guideline development group comprised 16 rheumatologists, one physiatrist, one orthopaedic surgeon, two allied health professionals, and one evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points for management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of Medline, Embase, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA, and NICE reports was used to identify the best available research evidence to support each proposition. Where possible, the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety, and incremental cost effectiveness ratio was used for cost effectiveness. The strength of recommendation was provided according to research evidence, clinical expertise, and perceived patient preference.
Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (for example, clinical features, risk factors, comorbidities), non-pharmacological (for example, education plus exercise, local heat, and splint), pharmacological (for example, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX-2 inhibitors, systemic slow acting disease modifying drugs, intra-articular corticosteroids), and surgery. Of 17 treatment modalities, only six were supported by research evidence (education plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs, topical capsaicin, and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of the treatment, and clinical expertise.
Eleven key recommendations for treatment of hand OA were developed using a combination of research based evidence and expert consensus. The evidence was evaluated and the strength of recommendation was provided.
制定基于证据的手部骨关节炎（OA）管理建议。
多学科指南制定小组由16名风湿病学家、1名物理治疗师、1名骨科医生、2名专职医疗人员和1名循证医学专家组成，代表15个不同的欧洲国家。每位参与者提出了多达10条描述手部OA管理关键临床要点的建议。最终建议采用德尔菲共识法达成一致。通过系统检索Medline、Embase、CINAHL、科学引文索引、AMED、Cochrane图书馆、卫生技术评估报告和英国国家卫生与临床优化研究所（NICE）报告，以确定支持每条建议的最佳现有研究证据。在可能的情况下，计算疗效的效应量和治疗所需人数。估计安全性的相对风险或比值比，并使用增量成本效益比评估成本效益。根据研究证据、临床专业知识和患者的感知偏好给出推荐强度。
通过三轮德尔菲法产生了11条涉及17种治疗方式的关键建议。治疗主题包括一般考虑因素（如临床特征、危险因素、合并症）、非药物治疗（如教育加运动、局部热敷和夹板）、药物治疗（如对乙酰氨基酚、非甾体抗炎药、非甾体抗炎药加胃保护剂、COX-2抑制剂、全身慢作用抗风湿药、关节内注射皮质类固醇）和手术。17种治疗方式中，只有6种有研究证据支持（教育加运动、非甾体抗炎药、COX-2抑制剂、外用非甾体抗炎药、外用辣椒素和硫酸软骨素）。其他则由影响其他关节部位的OA研究推断出的证据或专家意见支持。推荐强度根据证据水平、治疗的益处与危害/成本以及临床专业知识而有所不同。
结合基于研究的证据和专家共识，制定了11条手部OA治疗的关键建议。对证据进行了评估并给出了推荐强度。
