Why the viscosupplementation confusion?

Wednesday, 29 Jul 2015

If professional associations adopted similar methodology when developing guidelines there may not be so much confusion around whether intra-articular hyaluronic acid is an appropriate treatment for knee OA, rheumatologists and orthopaedic surgeons say.

Rheumatologist Roy Altman from the University of California in Los Angeles and colleagues noted that conflicting recommendations from leading professional bodies on the use of IA-HA in knee OA had led to confusion among treating physicians.

“The lack of consensus within the IA-HA treatment recommendations makes it difficult for clinicians to identify which guidelines should be followed when deciding to treat knee OA with IA-HA,” they wrote in their paper published in Seminars in Arthritis and Rheumatism. 

Assessment tools such as the AGREE II tool had been created to aid in the evaluation of guideline quality, yet there was still no “standard” methodology for a group to use when formulating guidelines.

They hoped that by examining the methodology used in the current guidelines some clarity would be brought to the issue.

As expected their analysis of 10 “high-impact” guidelines — including ACR, EULAR, OARSI and RACGP — found “highly inconsistent” recommendations across the board.

For instance 30% recommended against the use of intra-articular hyaluronic acid in the treatment of knee osteoarthritis, while 30% deemed the treatment an appropriate intervention under certain scenarios.

The remaining 40% of the guidelines provided either an uncertain recommendation or no recommendation at all.

They discovered a general lack of a standard and consistent methodology in evidence inclusion, evidence assessment, recommendation formation, and work group composition were the reasons behind the inconsistency.

“No clear “standard” method is available for assessing trial outcomes, leaving each organization to decide which assessment methodology they believe to be the most appropriate,” they wrote in Seminars in Arthritis and Rheumatism. 

“There is a need for a standard “appropriate methodology” that is agreed upon for osteoarthritis clinical practice guidelines in order to prevent the development of conflicting recommendations,” they concluded.

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