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EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis

Zhang, W.; Doherty, M.; Peat, G.; Bierma-Zeinstra, S. M. A.; Arden, N. K.; Bresnihan, B.; Herrero-Beaumont, G.; Kirschner, S.; Leeb, B. F. and Lohmander, Stefan LU , et al. (2010) In Annals of the Rheumatic Diseases 69(3). p.483-489
Abstract
Objective To develop evidence-based recommendations for the diagnosis of knee osteoarthritis (OA). Methods The multidisciplinary guideline development group, representing 12 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched systematically. Whenever possible, the sensitivity, specificity and likelihood ratio were calculated for individual diagnostic indicators and a diagnostic ladder was developed using Bayes' method. Secondary analyses were undertaken to test directly the recommendations using multiple predictive models in two populations from the UK and the Netherlands. Strength of recommendation was assessed by the EULAR visual... (More)
Objective To develop evidence-based recommendations for the diagnosis of knee osteoarthritis (OA). Methods The multidisciplinary guideline development group, representing 12 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched systematically. Whenever possible, the sensitivity, specificity and likelihood ratio were calculated for individual diagnostic indicators and a diagnostic ladder was developed using Bayes' method. Secondary analyses were undertaken to test directly the recommendations using multiple predictive models in two populations from the UK and the Netherlands. Strength of recommendation was assessed by the EULAR visual analogue scale. Results Recommendations covered the definition of knee OA and its risk factors, subsets, typical symptoms and signs, the use of imaging and laboratory tests and differential diagnosis. Three symptoms (persistent knee pain, limited morning stiffness and reduced function) and three signs (crepitus, restricted movement and bony enlargement) appeared to be the most useful. Assuming a 12.5% background prevalence of knee OA in adults aged >= 45 years, the estimated probability of having radiographic knee OA increased with increasing number of positive features, to 99% when all six symptoms and signs were present. The performance of the recommendations in the study populations varied according to the definition of knee OA, background risk and number of tests applied. Conclusion 10 key recommendations for diagnosis of knee OA were developed using both research evidence and expert consensus. Although there is no agreed reference standard, thorough clinical assessment alone can provide a confident rule-in diagnosis. (Less)
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Contribution to journal
publication status
published
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in
Annals of the Rheumatic Diseases
volume
69
issue
3
pages
483 - 489
publisher
British Medical Association
external identifiers
  • wos:000275458700003
  • scopus:77949480331
ISSN
1468-2060
DOI
10.1136/ard.2009.113100
language
English
LU publication?
yes
id
c5fa4986-e911-4099-93fa-5eab80331fe8 (old id 1589205)
date added to LUP
2010-04-20 13:11:55
date last changed
2018-07-22 03:44:34
@article{c5fa4986-e911-4099-93fa-5eab80331fe8,
  abstract     = {Objective To develop evidence-based recommendations for the diagnosis of knee osteoarthritis (OA). Methods The multidisciplinary guideline development group, representing 12 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched systematically. Whenever possible, the sensitivity, specificity and likelihood ratio were calculated for individual diagnostic indicators and a diagnostic ladder was developed using Bayes' method. Secondary analyses were undertaken to test directly the recommendations using multiple predictive models in two populations from the UK and the Netherlands. Strength of recommendation was assessed by the EULAR visual analogue scale. Results Recommendations covered the definition of knee OA and its risk factors, subsets, typical symptoms and signs, the use of imaging and laboratory tests and differential diagnosis. Three symptoms (persistent knee pain, limited morning stiffness and reduced function) and three signs (crepitus, restricted movement and bony enlargement) appeared to be the most useful. Assuming a 12.5% background prevalence of knee OA in adults aged >= 45 years, the estimated probability of having radiographic knee OA increased with increasing number of positive features, to 99% when all six symptoms and signs were present. The performance of the recommendations in the study populations varied according to the definition of knee OA, background risk and number of tests applied. Conclusion 10 key recommendations for diagnosis of knee OA were developed using both research evidence and expert consensus. Although there is no agreed reference standard, thorough clinical assessment alone can provide a confident rule-in diagnosis.},
  author       = {Zhang, W. and Doherty, M. and Peat, G. and Bierma-Zeinstra, S. M. A. and Arden, N. K. and Bresnihan, B. and Herrero-Beaumont, G. and Kirschner, S. and Leeb, B. F. and Lohmander, Stefan and Mazieres, B. and Pavelka, K. and Punzi, L. and So, A. K. and Tuncer, T. and Watt, I. and Bijlsma, J. W.},
  issn         = {1468-2060},
  language     = {eng},
  number       = {3},
  pages        = {483--489},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis},
  url          = {http://dx.doi.org/10.1136/ard.2009.113100},
  volume       = {69},
  year         = {2010},
}