BACKGROUND: In this work, we aimed to establish a clinical target in the management of knee osteoarthritis (KOA) and to propose good clinical practice (GCP) statements for carrying out a treat-to-target strategy. METHODS: A steering committee of seven experts had formulated a provisional set of recommendations that were exposed for discussion and modification to a technical expert panel (TEP) of 25 multidisciplinary experts from Europe, North America, South America and Asia. The level of evidence and strength of each recommendation was discussed. The TEP formulated overarching principles and GCP statements based on the level of agreement for each item with a vote using a 10-point numerical scale. RESULTS: Two overarching principles and 10 GCP statements were formulated by the TEP. These GCP statements suggest: treatment should achieve clinical improvement bringing the patient to the Patient Acceptable Symptom State (PASS); pharmacological and nonpharmacological treatment should begin as early as possible, with an early diagnosis of symptomatic KOA; the patient should be evaluated every 3-6 months; risk factors of KOA progression should be identified and managed with patients at the beginning of the treatment and monitored regularly; treatment should be adapted according to patient phenotype and disease severity; healthy lifestyle must be promoted and monitored. The level of agreement average ranged from 8.7 to 9.6 on scale. CONCLUSIONS: The proposed overarching principles and GCP statements have the aim of involving patients, general practitioners and multidisciplinary specialists in sharing a therapeutic treat-to-target strategy for KOA management based on the best evidence and expert opinions.

2nd Rehabilitation Department Rehabilitation Clinical Hospital Cluj Napoca Romania

Academic Department of Orthopaedics Hull and East Yorkshire NHS Trust Castle Hill Hospital Cottingham UK

Centre for Treatment Comparison and Integrative Analysis Division of Rheumatology Tufts Medical Centre Boston MA USA

Chirurgia Ortopedica Mininvasiva e Nuove Tecnologie Humanitas Research Hospital Castellanza Italy

Department of Emergency Medicine Dr Ram Manohar Lohia Hospital Lucknow India

Department of Experimental and Clinical Medicine University of Florence Florence Italy

Department of Family Medicine School of Kinesiology University Western Ontario Ontario Canada

Department of Internal Medicine and Rheumatology Sf Maria Hospital University of Medicine and Pharmacy 'Carol Davila' Bucharest Romania

Department of Medical and Surgical Specialties and Dentistry University of Campania 'L Vanvitelli' Caserta Italy

Department of Metabolic Diseases of Bone and Joints VA Nasonova Research Institute of Rheumatology Moscow Russian Federation

Department of Orthopaedics and Traumatology 'Policlinico Tor Vergata' Foundation Rome Italy

Department of Orthopaedics and Traumatology University of Campinas São Paulo Brazil

Department of Physical Medicine and Rehabilitation Division of Pain Medicine Istanbul University Istanbul Turkey

Department of Rheumatology Belorussian State Medical University Minsk Belarus

Division of Rheumatology and Clinical Immunology Humanitas Research Hospital Via A Manzoni 56 Rozzano Milan 20089 Italy

EUPATI Graduate and Patient Advocate Brussels Belgium

Institute of Rheumatology Prague Czech Republic

Institute of Rheumatology University of Belgrade Medical School Belgrade Serbia

Joint and Bone Research Unit IIS Fundacion Jimenez Diaz UAM Madrid Spain

Orthopaedic Department Johanna Etienne Hospital Neuss Germany

Physical Rehabilitation Medicine Department Rovisco Pais Medical and Rehabilitation Centre Tocha Portugal

Rheumatology Department AP HP Saint Antoine Hospital Paris France

Rheumatology Unit San Pietro Fatebenefratelli Hospital Rome Italy

Service de Rhumatologie Hôpital Nord Franche Belfort France

Unit of Rheumatology Henri Mondor Hospital Créteil France

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Early Osteoarthritis Questionnaire (EOAQ): a tool to assess knee osteoarthritis at initial stage