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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.

Abstract

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published a treatment algorithm for the management of knee osteoarthritis (OA) in 2014, which provides practical guidance for the prioritization of interventions. Further analysis of real-world data for OA provides additional evidence in support of pharmacological interventions, in terms of management of OA pain and function, avoidance of adverse events, disease-modifying effects and long-term outcomes, e.g., delay of total joint replacement surgery, and pharmacoeconomic factors such as reduction in healthcare resource utilization. This article provides an updated assessment of the literature for selected interventions in OA, focusing on real-life data, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA in primary care clinical practice, in support of the clinicians' individualized assessment of the patient. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) is recommended, for which high-quality evidence is provided only for the prescription formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs without the systemic safety concerns. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk:benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

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  • Authors+Show Affiliations

    ,

    Support Unit in Epidemiology and Biostatistics, Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman, Liège 4000, Belgium. Electronic address: olivier.bruyere@ulg.ac.be.

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    MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.

    ,

    Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.

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    Rheumatology Department, AP-HP, Saint-Antoine Hôpital, Paris, France.

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    Rehabilitation Unit, Rheumatology Department, Hôpital Cochin, AP-HP, INSERM UMR-S 1124, Université Paris Descartes, Paris, France.

    ,

    CEDOC, Department of Rheumatology, Faculdade de Ciências Médicas, Universidade Nova de Lisboa/CHLO, EPE-Hospital Egas Moniz, Lisbon, Portugal.

    ,

    Department of Internal Medicine, University of Florence, Florence, Italy.

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    WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.

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    David Geffen School of Medicine, University of California, Los Angeles, CA.

    ,

    Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Geriatric Research, Education and Clinical Center, Baltimore, MD; Health Care System, Baltimore, MD.

    ,

    Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.

    Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.

    Source

    Seminars in arthritis and rheumatism 45:4 Suppl 2016 Feb pg S3-11

    MeSH

    Acetaminophen
    Analgesics
    Chondroitin Sulfates
    Evidence-Based Medicine
    Glucosamine
    Humans
    Musculoskeletal Pain
    Osteoarthritis, Knee
    Viscosupplements

    Pub Type(s)

    Consensus Development Conference
    Journal Article

    Language

    eng

    PubMed ID

    26806188

    Citation

    Bruyère, Olivier, et al. "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." Seminars in Arthritis and Rheumatism, vol. 45, no. 4 Suppl, 2016, pp. S3-11.
    Bruyère O, Cooper C, Pelletier JP, et al. 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. 2016;45(4 Suppl):S3-11.
    Bruyère, O., Cooper, C., Pelletier, J. P., Maheu, E., Rannou, F., Branco, J., ... Reginster, J. Y. (2016). 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. Seminars in Arthritis and Rheumatism, 45(4 Suppl), pp. S3-11. doi:10.1016/j.semarthrit.2015.11.010.
    Bruyère O, et al. 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. 2016;45(4 Suppl):S3-11. PubMed PMID: 26806188.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - 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. AU - Bruyère,Olivier, AU - Cooper,Cyrus, AU - Pelletier,Jean-Pierre, AU - Maheu,Emmanuel, AU - Rannou,François, AU - Branco,Jaime, AU - Luisa Brandi,Maria, AU - Kanis,John A, AU - Altman,Roy D, AU - Hochberg,Marc C, AU - Martel-Pelletier,Johanne, AU - Reginster,Jean-Yves, Y1 - 2015/12/02/ PY - 2015/10/12/received PY - 2015/11/12/revised PY - 2015/11/25/accepted PY - 2016/1/26/entrez PY - 2016/1/26/pubmed PY - 2016/12/15/medline KW - Chondroitin KW - Glucosamine KW - Hyaluronic acid KW - Knee osteoarthritis KW - Non-steroidal anti-inflammatory drugs KW - Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) KW - Tramadol SP - S3 EP - 11 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 45 IS - 4 Suppl N2 - The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published a treatment algorithm for the management of knee osteoarthritis (OA) in 2014, which provides practical guidance for the prioritization of interventions. Further analysis of real-world data for OA provides additional evidence in support of pharmacological interventions, in terms of management of OA pain and function, avoidance of adverse events, disease-modifying effects and long-term outcomes, e.g., delay of total joint replacement surgery, and pharmacoeconomic factors such as reduction in healthcare resource utilization. This article provides an updated assessment of the literature for selected interventions in OA, focusing on real-life data, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA in primary care clinical practice, in support of the clinicians' individualized assessment of the patient. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) is recommended, for which high-quality evidence is provided only for the prescription formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs without the systemic safety concerns. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk:benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/26806188/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(15)00288-7 DB - PRIME DP - Unbound Medicine ER -