The standardised operating procedures for European League Against Rheumatism (EULAR)-endorsed recommendations were followed, including a systematic literature review and definition of the strength of recommendations by a task force of experts. The recommendations regarding management options mostly include advice with sufficient data-driven evidence, whereas the overarching principles and recommendations regarding assessment are based on expert opinion because they could not be substantiated with evidence from systematic reviews. A multidisciplinary task force including professionals and patient representatives conducted a systematic review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2,914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of inflammatory arthritis (IA) and osteoarthritis (OA) pathogenesis, and to be able to differentiate localised and generalized pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.
Geenen R, et al. Ann Rheum Dis 2018;77:797–807. doi:10.1136/annrheumdis-2017-212662