背景：尽管骨关节炎（OA）管理的国际循证指南的可用性，对不同的治疗方式缺乏一致意见。
方法：在年度欧洲风湿病学会议的框架内举行了欧洲和美国OA专家研讨会，以讨论和比较膝关节OA治疗的指南和建议，并达成管理共识。特别是在没有明确共识的领域:非药物治疗;镇痛药和非甾体抗炎药(NSAIDs)的疗效和安全性;关节内(i.a.)透明质酸盐(HA);硫酸软骨素(CS)和/或硫酸葡糖胺(GS)的作用.
结果：所审查的所有指南都同意膝关节OA是一种进行性关节疾病，其治疗需要非药物和药物方法。指南之间的差异很少，并且主要反映了所涉及的专家小组的异质性，药物疗法可用性的地理差异，和异质性的研究包括。为指南制定选择的小组应包括在药物使用和患者管理方面具有实际临床经验的专家。药物供应和报销计划会阻碍商定准则的实施，导致最佳OA治疗受到威胁，HA和用于骨关节炎的症状缓慢作用药物（SySADOAs）是药物的明显例子，其可用性和处方在地理上可能差异很大。此外,初级保健提供者，通常负责OA管理（至少在疾病早期），可能不遵守临床护理指南，特别是对于非药物OA治疗。
结论：协调膝关节OA治疗的建议具有挑战性，但可行，如欧洲骨质疏松症和骨关节炎临床和经济方面协会（ESCEO）开发的逐步治疗算法所示。在初级保健环境中更容易传播和实施OA治疗指南是改善OA管理的关键。
BACKGROUND: Despite availability of international evidence-based
guidelines for osteoarthritis (OA) management, agreement on the different treatment modalities is lacking.
METHODS: A symposium of European and US OA experts was held within the framework of the Annual European Congress of Rheumatology to discuss and compare guidelines and recommendations for the treatment of knee OA and to reach a
consensus for management, particularly for areas in which there is no clear
consensus: non-pharmacological therapy; efficacy and safety of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs); intra-articular (i.a.) hyaluronates (HA); and the role of chondroitin sulfate (CS) and/or glucosamine sulfate (GS).
RESULTS: All
guidelines reviewed agree that knee OA is a progressive disease of the joint whose management requires non-pharmacological and pharmacological approaches. Discrepancies between guidelines are few and mostly reflect heterogeneity of expert panels involved, geographical differences in the availability of pharmacotherapies, and heterogeneity of the studies included. Panels chosen for
guideline development should include experts with real clinical experience in drug use and patient management. Implementation of agreed guidelines can be thwarted by drug availability and reimbursement plans, resulting in optimal OA treatment being jeopardized, HA and symptomatic slow-acting drugs for osteoarthritis (SySADOAs) being clear examples of drugs whose availability and prescription can greatly vary geographically. In addition, primary care providers, often responsible for OA management (at least in early disease), may not adhere to clinical care guidelines, particularly for non-pharmacological OA treatment.
CONCLUSIONS: Harmonization of the recommendations for knee OA treatment is challenging but feasible, as shown by the step-by-step therapeutic algorithm developed by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). More easily disseminated and implemented guidance for OA treatment in the primary care setting is key to improved management of OA.
