Investigating the Diagnosis, Management, and Emerging Therapeutic Advances in Osteoarthritis: A Narrative Review

Question: Osteoarthritis (OA) is a degenerative joint disease and a major cause of chronic pain and disability worldwide, particularly among older adults.
Finding: It is characterized by progressive articular cartilage degeneration and structural and biochemical changes in subchondral bone, synovium, ligaments, and periarticular muscles.
Meaning: This narrative review summarizes current diagnostic approaches, established management strategies, and emerging therapeutic developments in OA, emphasizing the continued need for reliable biomarkers and effective disease-modifying therapies.

Article summary

Abstract

Osteoarthritis (OA) is a degenerative joint disease and a major cause of chronic pain and disability worldwide, particularly among older adults. It is characterized by progressive articular cartilage degeneration and structural and biochemical changes in subchondral bone, synovium, ligaments, and periarticular muscles. OA is not simply a mechanical “wear-and-tear” disorder; it is now recognized as a multifactorial disease involving mechanical, genetic, metabolic, and low-grade inflammatory processes.

Diagnosis is largely clinical and may be supported by imaging findings such as joint-space narrowing, osteophyte formation, and subchondral sclerosis, while laboratory testing is generally used to exclude inflammatory, infectious, or metabolic arthritides. Management is stepwise: non-pharmacological measures, including exercise and weight loss when appropriate, are foundational; pharmacological therapy may then be added, with topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) commonly used and opioids generally discouraged except in selected circumstances. Intra-articular corticosteroid injections may provide short-term symptom relief, and total joint replacement remains the most effective treatment for appropriately selected patients with end-stage disease. Emerging approaches, including platelet-rich plasma, mesenchymal stem-cell therapies, targeted molecular agents, and disease-modifying osteoarthritis drugs, remain investigational because evidence is inconsistent and disease modification has not been established.

This narrative review summarizes current diagnostic approaches, established management strategies, and emerging therapeutic developments in OA, emphasizing the continued need for reliable biomarkers and effective disease-modifying therapies.

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Objective, principal result, and takeaway derived from complete abstract sections without mid-sentence truncation.

Objective

Osteoarthritis (OA) is a degenerative joint disease and a major cause of chronic pain and disability worldwide, particularly among older adults.

Key finding

It is characterized by progressive articular cartilage degeneration and structural and biochemical changes in subchondral bone, synovium, ligaments, and periarticular muscles.

Clinical takeaway

This narrative review summarizes current diagnostic approaches, established management strategies, and emerging therapeutic developments in OA, emphasizing the continued need for reliable biomarkers and effective disease-modifying therapies.

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ReceivedSeptember 12, 2026
AcceptedSeptember 17, 2026
PublishedSeptember 17, 2026

The Version of Record remains the authoritative article. Corrections, expressions of concern, and retractions are linked here when issued.

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License

This article is distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The author declares no conflicts of interest.

Author contributions

Syeda Alizay Fatima: Conceptualization, literature search, evidence synthesis, critical appraisal, manuscript drafting, revision, and final approval of the manuscript. The author is responsible for all aspects of the work and has approved the final version for publication.

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Data availability is not applicable to this article, as no new datasets were generated or analyzed.

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Not Applicable

References

Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. The Lancet. 2019;393(10182):1745-1759. Scholar ↗
Hossain MS, Lee HJ, Hossain R, Kim CM, Lee CJ, Hwang SC. Recent advances in therapeutic approaches for knee osteoarthritis: a narrative review. Biomolecules & Therapeutics. 2025;34(1):80-101. Scholar ↗
Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthritis and Cartilage. 2022;31(4). Available from: [https://www.sciencedirect.com/science/article/pii/S1063458422009281](https://www.sciencedirect.com/science/article/pii/S1063458422009281) Scholar ↗
Ton J, Perry D, Thomas B, Allan GM, Lindblad AJ, McCormack J, et al. PEER umbrella systematic review of systematic reviews: management of osteoarthritis in primary care. Canadian Family Physician. 2020;66(3):e89-e98. Scholar ↗
Mohammadinejad R, Ashrafizadeh M, Pardakhty A, Uzieliene I, Denkovskij J, Bernotiene E, et al. Nanotechnological strategies for osteoarthritis diagnosis, monitoring, clinical management, and regenerative medicine: recent advances and future opportunities. Current Rheumatology Reports. 2020;22(4). Scholar ↗
Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research. 2020;72(2):149-162. Scholar ↗
Langworthy M, Dasa V, Spitzer AI. Knee osteoarthritis: disease burden, available treatments, and emerging options. Therapeutic Advances in Musculoskeletal Disease. 2024;16. Scholar ↗
Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis and Rheumatism. 2012;64(6):1697-1707. Scholar ↗
Hadzic E, Beier F. Emerging therapeutic targets for osteoarthritis. Expert Opinion on Therapeutic Targets. 2023;27(2):111-120. Scholar ↗
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. Scholar ↗
GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5(9):e508-e522. Scholar ↗
Yan L, Li D, Xing D, Fan Z, Du G, Jiu J, Li X, Estill J, Wang Q, Belal AA, et al. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ. 2025;391:e085242. Scholar ↗
Weng Q, Goh SL, Wu J, Persson MSM, Wei J, Sarmanova A, et al. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2023;57(15):990-996. Scholar ↗
Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273. Scholar ↗
McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975. Scholar ↗
Xiong Y, Gong C, Peng X, Liu X, Su X, Tao X, Li Y, Wen Y, Li W. Efficacy and safety of platelet-rich plasma injections for the treatment of osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine. 2023;10:1204144. Scholar ↗
Tian X, Qu Z, Cao Y, Zhang B. Relative efficacy and safety of mesenchymal stem cells for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Endocrinology. 2024;15:1366297. Scholar ↗
Mautner K, Gottschalk M, Boden SD, Akard A, Bae WC, Black L, et al. Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nature Medicine. 2023;29(12):3120-3126. Scholar ↗
Hochberg MC, Guermazi A, Guehring H, Aydemir A, Wax S, Fleuranceau-Morel P, et al. Effect of intra-articular sprifermin vs placebo on femorotibial joint cartilage thickness in patients with osteoarthritis: the FORWARD randomized clinical trial. JAMA. 2019;322(14):1360-1370. Scholar ↗
Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: a systematic review. HSS Journal. 2018;14(2):192-201. Scholar ↗
Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial. Journal of Telemedicine and Telecare. 2018;24(8):560-565. Scholar ↗
Berenbaum F, Blanco FJ, Guermazi A, Miki K, Yamabe T, Viktrup L, Junor R, Carey W, Brown MT, West CR, Verburg KM. Subcutaneous tanezumab for osteoarthritis of the hip or knee: efficacy and safety results from a 24-week randomised phase III study with a 24-week follow-up period. Annals of the Rheumatic Diseases. 2020;79(6):800-810. Scholar ↗
Pfizer Inc, Eli Lilly and Company. Joint FDA Advisory Committee Votes on Application for Tanezumab for the Treatment of Osteoarthritis Pain [press release]. March 25, 2021. Scholar ↗
UNITY Biotechnology, Inc. UNITY Biotechnology Announces 12-Week Data from UBX0101 Phase 2 Clinical Study in Patients with Painful Osteoarthritis of the Knee [press release]. South San Francisco, CA; August 17, 2020. Scholar ↗
Meglio M. Cell Therapy TG-C Misses Primary Endpoints in Phase 3 Knee Osteoarthritis Trial. CGTLive [Internet]. July 23, 2026 [cited 2026 Sep 10]. Available from: [https://www.cgtlive.com/view/cell-therapy-tg-c-misses-primary-endpoints-phase-3-knee-osteoarthritis-trial](https://www.cgtlive.com/view/cell-therapy-tg-c-misses-primary-endpoints-phase-3-knee-osteoarthritis-trial) Scholar ↗
National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022. Scholar ↗

How to Cite

Syeda Alizay Fatima. Investigating the Diagnosis, Management, and Emerging Therapeutic Advances in Osteoarthritis: A Narrative Review. Int J Clin Innov. 2026;1(1).

Received September 12, 2026 · Accepted September 17, 2026

Creative Commons Attribution 4.0 International (CC BY 4.0)

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Pulmonary Carcinoid Tumors as an Asthma Mimic: Diagnostic Challenges, Clinical Presentation, and Management Strategies

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Asthma is a common chronic respiratory disease; however, some patients continue to have symptoms despite appropriate guideline-directed therapy. Pulmonary carcinoids are rare, well-differentiated neuroendocrine neoplasms that may cause cough, wheeze, dyspnea, hemoptysis, and recurrent infection through focal airway obstruction, thereby mimicking asthma. This review summarizes the pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, and management of pulmonary carcinoid tumors presenting as an asthma mimic and highlights clinical features that should prompt reconsideration of an asthma diagnosis. This is a narrative, non-systematic review. A structured search and screening process was used specifically to identify the case-level literature summarized in Table 1, but this does not constitute a systematic review: only one database was searched, no protocol was registered or pre-published, and findings are synthesized narratively rather than through meta-analysis. The search strategy used combinations of the terms “pulmonary carcinoid,” “bronchial carcinoid,” “asthma mimic,” “endobronchial tumor,” “refractory asthma,” and “unilateral wheezing” to identify 14 English-language case-level reports of carcinoid tumors presenting with or mimicking asthma; seven of these are included in the present review (Table 1), while seven others were excluded (four for an irrelevant clinical scenario, two for an alternative diagnosis of adenoid cystic carcinoma, and one for carcinoid syndrome without asthma-like features in a patient with COPD). Inclusion/exclusion followed a priori eligibility criteria established prospectively, before screening began. Screening was performed by a single reviewer, with a second-pass re-screening of all records by the same reviewer to check consistency, since no second, independent screener was available; there were no discrepancies between the two passes. A PRISMA flow diagram was not produced, consistent with the narrative, non-systematic design of this review. The included case reports were assessed using four of the CARE reporting domains (demographics, work-up, treatment, outcome/follow-up) as a means of appraisal of reporting quality rather than formal risk-of-bias assessment; results of this informal appraisal are described rather than pooled. Pulmonary carcinoid tumors are usually indolent neuroendocrine neoplasms, but centrally located lesions can narrow a major airway and cause wheeze, cough, dyspnea, hemoptysis, and post-obstructive infection. Because this presentation can resemble asthma, diagnosis may be delayed despite escalating inhaled therapy or consideration of biologic treatment. Features that should raise suspicion for a focal endobronchial lesion include localized or unilateral wheeze, adult-onset or atypical symptoms, poor or incomplete response to appropriate asthma therapy, recurrent infection in the same lung segment, hemoptysis, asymmetric breath sounds, or unexpected imaging findings. Chest CT and bronchoscopy, followed by histopathology and neuroendocrine immunohistochemistry when tissue sampling is appropriate, are central to diagnosis and to distinguishing typical from atypical carcinoids. Complete surgical resection remains the preferred treatment for most localized, resectable pulmonary carcinoid tumors. Bronchoscopic/endoscopic treatments, including Nd:YAG laser photoresection, electrocautery or snare resection, cryotherapy, and rigid bronchoscopic debulking, may be considered as parenchyma-sparing approaches in carefully selected patients with strictly intraluminal typical carcinoids; available evidence is largely retrospective and direct comparative evidence against surgery remains limited. For unresectable or metastatic disease, treatment may include somatostatin analogues, peptide receptor radionuclide therapy, targeted therapy, and other individualized systemic options. Pulmonary carcinoid should be considered in patients with persistent or atypical asthma-like symptoms that do not respond as expected to guideline-directed therapy. Early recognition permits timely CT imaging, bronchoscopic evaluation, histopathologic confirmation, and definitive management; surgical resection remains standard for most localized resectable tumors, while selected strictly intraluminal typical carcinoids may be considered for bronchoscopic treatment.

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Original ArticleAnesthesiology

24-Hour Analgesic Outcomes After Ultrasound-Guided Bilateral Superficial Cervical Plexus Block With Perineural Dexamethasone for Thyroid Surgery: A Prospective Single-Center Case Series

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Bilateral superficial cervical plexus block (BSCPB) is used within multimodal analgesia for thyroid surgery, and dexamethasone has been studied as an adjunct intended to prolong block-related analgesia. Because this study had no comparator group, its findings are interpreted as descriptive outcomes of a combined anesthetic and regional-analgesia protocol rather than as evidence of dexamethasone efficacy. To describe 24-hour postoperative pain, rescue-analgesic requirements, and reported block-related complications in adults undergoing thyroid surgery who received ultrasound-guided BSCPB with bupivacaine and perineural dexamethasone. This prospective single-center case series included 12 adults from a source population of 21 patients scheduled for thyroid surgery at Hospital Ana Francisca Pérez de León II between January and June 2025. All underwent general anesthesia followed by ultrasound-guided bilateral superficial cervical plexus block using a 10-mL preparation containing bupivacaine 25 mg (final concentration 0.25%) and dexamethasone 4 mg; the source thesis did not specify the exact volume injected per side. Pain was assessed on a 0–10 numerical rating scale at 30 minutes, 2 hours, 12 hours, and 24 hours. Protocol-defined analgesic failure was a score ≥4 at a scheduled assessment or a patient request for rescue medication; ketorolac 30 mg sublingually was the rescue regimen. All 12 patients were ASA physical status II. At 30 minutes and 2 hours, 1 patient (8.3%) reported no pain and 11 (91.7%) reported mild pain (scores 1–3). At 12 and 24 hours, all 12 patients (100%) had mild pain; no moderate or severe pain was reported at any scheduled assessment. No patient met the predefined failure criterion or required rescue analgesia (12/12; post hoc exact 95% CI, 73.5%–100%). No block-related complication was reported in the aggregated source results (0/12; post hoc exact 95% CI, 0%–26.5%). Favorable 24-hour pain and rescue-analgesia outcomes were observed after the combined general-anesthesia and BSCPB protocol. The small single-arm sample, systemic analgesic cointerventions, incomplete reporting of several planned outcomes, and absence of a comparator prevent causal attribution to perineural dexamethasone or definitive conclusions regarding safety.

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Intravenous Dexmedetomidine as an Adjunct to Spinal Anesthesia for Lower-Extremity Orthopedic Surgery: A Randomized Controlled Study

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September 14, 2026Anesthesiology

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[reference-1] Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. The Lancet. 2019;393(10182):1745-1759. Scholar ↗

[reference-2] Hossain MS, Lee HJ, Hossain R, Kim CM, Lee CJ, Hwang SC. Recent advances in therapeutic approaches for knee osteoarthritis: a narrative review. Biomolecules & Therapeutics. 2025;34(1):80-101. Scholar ↗

[reference-3] Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthritis and Cartilage. 2022;31(4). Available from: [https://www.sciencedirect.com/science/article/pii/S1063458422009281](https://www.sciencedirect.com/science/article/pii/S1063458422009281) Scholar ↗

[reference-4] Ton J, Perry D, Thomas B, Allan GM, Lindblad AJ, McCormack J, et al. PEER umbrella systematic review of systematic reviews: management of osteoarthritis in primary care. Canadian Family Physician. 2020;66(3):e89-e98. Scholar ↗

[reference-5] Mohammadinejad R, Ashrafizadeh M, Pardakhty A, Uzieliene I, Denkovskij J, Bernotiene E, et al. Nanotechnological strategies for osteoarthritis diagnosis, monitoring, clinical management, and regenerative medicine: recent advances and future opportunities. Current Rheumatology Reports. 2020;22(4). Scholar ↗

[reference-6] Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research. 2020;72(2):149-162. Scholar ↗

[reference-7] Langworthy M, Dasa V, Spitzer AI. Knee osteoarthritis: disease burden, available treatments, and emerging options. Therapeutic Advances in Musculoskeletal Disease. 2024;16. Scholar ↗

[reference-8] Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ. Arthritis and Rheumatism. 2012;64(6):1697-1707. Scholar ↗

[reference-9] Hadzic E, Beier F. Emerging therapeutic targets for osteoarthritis. Expert Opinion on Therapeutic Targets. 2023;27(2):111-120. Scholar ↗

[reference-10] Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. Scholar ↗

[reference-11] GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5(9):e508-e522. Scholar ↗

[reference-12] Yan L, Li D, Xing D, Fan Z, Du G, Jiu J, Li X, Estill J, Wang Q, Belal AA, et al. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ. 2025;391:e085242. Scholar ↗

[reference-13] Weng Q, Goh SL, Wu J, Persson MSM, Wei J, Sarmanova A, et al. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2023;57(15):990-996. Scholar ↗

[reference-14] Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273. Scholar ↗

[reference-15] McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967-1975. Scholar ↗

[reference-16] Xiong Y, Gong C, Peng X, Liu X, Su X, Tao X, Li Y, Wen Y, Li W. Efficacy and safety of platelet-rich plasma injections for the treatment of osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine. 2023;10:1204144. Scholar ↗

[reference-17] Tian X, Qu Z, Cao Y, Zhang B. Relative efficacy and safety of mesenchymal stem cells for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Endocrinology. 2024;15:1366297. Scholar ↗

[reference-18] Mautner K, Gottschalk M, Boden SD, Akard A, Bae WC, Black L, et al. Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. Nature Medicine. 2023;29(12):3120-3126. Scholar ↗

[reference-19] Hochberg MC, Guermazi A, Guehring H, Aydemir A, Wax S, Fleuranceau-Morel P, et al. Effect of intra-articular sprifermin vs placebo on femorotibial joint cartilage thickness in patients with osteoarthritis: the FORWARD randomized clinical trial. JAMA. 2019;322(14):1360-1370. Scholar ↗

[reference-20] Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: a systematic review. HSS Journal. 2018;14(2):192-201. Scholar ↗

[reference-21] Azma K, RezaSoltani Z, Rezaeimoghaddam F, Dadarkhah A, Mohsenolhosseini S. Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial. Journal of Telemedicine and Telecare. 2018;24(8):560-565. Scholar ↗

[reference-22] Berenbaum F, Blanco FJ, Guermazi A, Miki K, Yamabe T, Viktrup L, Junor R, Carey W, Brown MT, West CR, Verburg KM. Subcutaneous tanezumab for osteoarthritis of the hip or knee: efficacy and safety results from a 24-week randomised phase III study with a 24-week follow-up period. Annals of the Rheumatic Diseases. 2020;79(6):800-810. Scholar ↗

[reference-23] Pfizer Inc, Eli Lilly and Company. Joint FDA Advisory Committee Votes on Application for Tanezumab for the Treatment of Osteoarthritis Pain [press release]. March 25, 2021. Scholar ↗

[reference-24] UNITY Biotechnology, Inc. UNITY Biotechnology Announces 12-Week Data from UBX0101 Phase 2 Clinical Study in Patients with Painful Osteoarthritis of the Knee [press release]. South San Francisco, CA; August 17, 2020. Scholar ↗

[reference-25] Meglio M. Cell Therapy TG-C Misses Primary Endpoints in Phase 3 Knee Osteoarthritis Trial. CGTLive [Internet]. July 23, 2026 [cited 2026 Sep 10]. Available from: [https://www.cgtlive.com/view/cell-therapy-tg-c-misses-primary-endpoints-phase-3-knee-osteoarthritis-trial](https://www.cgtlive.com/view/cell-therapy-tg-c-misses-primary-endpoints-phase-3-knee-osteoarthritis-trial) Scholar ↗

[reference-26] National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022. Scholar ↗

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