Knee OA management

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Reasonable Rascal
Posts: 19
Joined: Mon Dec 12, 2016 1:13 pm
Location: Iowa

Knee OA management

Post by Reasonable Rascal » Thu Jan 19, 2017 5:13 am

Knee OA management: Consensus statement from ESCEO

Jan 29, 2016 Clinical Essentials from Semin Arthritis Rheum

Takeaway

European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
offers practical, sequential steps for the pharmacological management of OA, based on up-to-date
review of clinical studies.

Key findings

Steps for background maintenance therapy:

Prescription, patented crystalline glucosamine sulfate (GS) and chondroitin sulfate (CS), shown by good evidence to be effective for
treating OA symptoms.

The best randomized controlled trials on a prescription formulation of glucosamine sulfate (Rottapharm) show moderate pain relief.
Additional studies änd pain relief comparable to that provided by NSAIDS. A separate study found that glucosamine sulfate, compared to
paracetamol, provided better pain relief. Studies also found a reduction in joint space narrowing compared with placebo over 3 years of
treatment.

Studies using prescription-grade CS have shown that CS may offer similar beneäts on joint structure changes in patients with mild to
moderate OA, but reported magnitude of reported pain relief is variable.

There are no randomized controlled trials reported for the combination of the two pharmaceutical-grade prescription preparations of CS
and GS compared with CS or GS alone.

Due to growing safety concerns and limited efäcacy, paracetamol should be added only as a rescue pain medication. It has no signiäcant
effect on stiffness and physical function in patients with knee OA. Increasing evidence points to increased risk of upper gastrointestinal
(GI) events with chronic use, and risks to the liver and kidneys with higher dosages.

Bruyère O, Cooper C, Pelletier JP, Maheu E, Rannou F, Branco J, Luisa
Brandi M, Kanis JA, Altman RD, Hochberg MC, Martel-Pelletier J,
Reginster JY. A consensus statement on the European Society for
Clinical and Economic Aspects of Osteoporosis and Osteoarthritis
(ESCEO) algorithm for the management of knee osteoarthritis-From
evidence-based medicine to the real-life setting. Semin Arthritis
Rheum. 2015 Dec 2. pii: S0049-0172(15)00288-7. doi:
10.1016/j.semarthrit.2015.11.010. [Epub ahead of print] PubMed
PMID: 26806188

© 2016 Univadis International, Inc. All rights reserved.

Topical NSAIDs may provide additional symptomatic treatment with the same degree of efäcacy as oral NSAIDs, without the same degree
of systemic safety concerns. Bioavailability varies. Use of topical NSAIDs in inåammatory rheumatic diseases led to a 40% reduction in
need for concomitant oral NSAIDs, with fewer GI side effects reported.

For advanced management of persistent symptoms:

Oral NSAIDs are the ärst choice, but vary in GI and CV and safety proäles and must be chosen carefully for individuals.

A next step is intra-articular hyaluronic acid, efäcacious for up to 6 months after a short-course of weekly injections. The ESCEO task
force recommends the use of IA HA in knee OA patients with mild-moderate disease, and for more severe pain in patients who are
contraindicated for total knee replacement or who want to delay surgery.

Slow titration of sustained-release tramadol, can provide sustained pain relief and is more tolerable than other opioid options.
Why this matters

OA is expected to become the fourth leading cause of disability worldwide by 2020, according to the authors
We engage in medical practice only because we can never achieve medical perfection.

pa4ortho
Posts: 14
Joined: Wed Dec 14, 2016 8:42 pm

Re: Knee OA management

Post by pa4ortho » Tue Feb 07, 2017 11:27 pm

The results are just about the opposite of what we recommend here on the other side of the pond..... interesting.

hyaluronic acid helps 1/3 to 2/3rds of patients per the data, and that about what I see in the office,
GS CS both show no evidence of helping unless the study was funded by a manufacturer.
tyl still the #1 drug for DJD, with the same precautions listed.
nsaids similar.

pa4ortho

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