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See detailCost-effectiveness of personalized supplementation with vitamin D-rich dairy products in the prevention of osteoporotic fractures
Ethgen, Olivier ULg; Hiligsmann, Mickaël; Burlet, Nansa et al

in Osteoporosis International (2016), 27

Summary: Titrated supplementations with vitamin D-fortified yogurt, based on spontaneous calcium and vitamin D intakes, can be cost-effective in postmenopausal women with or without increased risk of ... [more ▼]

Summary: Titrated supplementations with vitamin D-fortified yogurt, based on spontaneous calcium and vitamin D intakes, can be cost-effective in postmenopausal women with or without increased risk of osteoporotic fractures. Introduction: The objective of this study is to assess the costeffectiveness of the vitamin D-fortified yogurt given to women with and without an increased risk of osteoporotic fracture. Methods: Avalidated cost-effectiveness microsimulation Markov model of osteoporosis management was used. Three personalized supplementation scenarios to reflect the Ca/Vit D needs taking into account the well-known variations in dietary habits and a possible pharmacological supplementation in Ca/ Vit D, given above or in combination with anti-osteoporosis medications: one yogurt per day, i.e., 400 mg of Ca+200 IU of Vit D (scenario 1 U), two yogurts per day, i.e., 800 mg of Ca+ 400 IU of Vit D (scenario 2 U), or three yogurts per day, i.e., 1, 200 mg of Ca+600 IU of Vit D (scenario 3 U). Results: One yogurt is cost-effective in the general population above the age of 70 years and in all age groups in women with low bone mineral density (BMD) or prevalent vertebral fracture (PVF). The daily intake of two yogurts is cost-effective above 80 years in the general population and above 70 years in the two groups of women at increased risk of fractures. However, an intake of three yogurts per day is only cost-effective above 80 years old in the general population, as well as in women with low BMD or PVF. Conclusions: Our study is the first economic analysis supporting the cost-effectiveness of dairy products, fortified with vitamin D, in the armamentarium against osteoporotic fractures. [less ▲]

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See detailHigh Kellgren-Lawrence Grade and Bone Marrow Lesions Predict Worsening Rates of Radiographic Joint Space Narrowing; The SEKOIA Study
Edwards, M.H.; Parsons, C.; Bruyère, Olivier ULg et al

in Journal of Rheumatology (2016), 43(3), 657-65

Objective. Determinants of radiographic progression in osteoarthritis (OA) are poorly understood. We investigated which features on baseline magnetic resonance imaging (MRI) acted as predictors of change ... [more ▼]

Objective. Determinants of radiographic progression in osteoarthritis (OA) are poorly understood. We investigated which features on baseline magnetic resonance imaging (MRI) acted as predictors of change in joint space width (JSW). Methods. A total of 559 men and women over the age of 50 years with clinical knee OA [Kellgren-Lawrence (KL) grade 2-3] were recruited to the placebo arm of the SEKOIA study (98 centers; 18 countries). Minimal tibiofemoral joint space and KL grade on plain radiograph of the knee were assessed at baseline and at yearly followup up to 3 years. In a subset, serial knee MRI examinations were performed. Individuals with a bone marrow lesion (BML) ≥ grade 2 at the tibiofemoral joint at baseline were classified as BML-positive. Relationships between change in JSW and risk factors were assessed using linear regression. Results. The mean age of study participants was 62.8 (SD 7.5) years and 73% were female; 38.6% had BML. Mean baseline JSW was 3.65 mm. This reduced by 0.18 (0.30) mm/year in men and 0.13 (0.23) mm/year in women. Those with BML had a significantly higher rate of annualized change in JSW; this relationship remained robust after adjustment for age, sex, and baseline KL grade [β = –0.10 (95% CI –0.18, –0.02) mm/yr]. Age, sex, baseline KL grade, and other MRI findings did not influence the rate of change in JSW. Conclusion. The rate of change in JSW was similar in men and women. BML on knee MRI predicted the rate of radiographic change in JSW. This relationship was independent of age, sex, and baseline KL grade. (First Release January 15 2016; J Rheumatol 2016;43:657–65; doi:10.3899/jrheum.150053) [less ▲]

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See detailClinical trials of new drugs for the treatment of rheumatoid arthritis: focus on early disease
SMOLEN, J.S.; COLLAUD BASSET, S.; BOERS, M. et al

in Annals of Rheumatic Diseases (2016), 75

The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened a task force of experts in rheumatoid arthritis (RA) and clinical trial ... [more ▼]

The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened a task force of experts in rheumatoid arthritis (RA) and clinical trial methodology to comment on the new draft ‘Guideline on clinical investigation of medicinal products for the treatment of RA’ released by the European Medicines Agency (EMA). Special emphasis was placed by the group on the development of new drugs for the treatment of early RA. In the absence of a clear definition of early RA, it was suggested that clinical investigations in this condition were conducted in disease-modifying antirheumatic drugs naïve patients with no more than 1 year disease duration. The expert group recommended using an appropriate improvement in disease activity (American College of Rheumatology (ACR) or Simplified/Clinical Disease Activity Index (SDAI/CDAI) response criteria) or low disease activity (by any score) as primary endpoints, with ACR/European League Against Rheumatism remission as a secondary endpoint. Finally, as compelling evidence showed that the Disease Acrivity Score using 28-joint counts (DAS28) might not provide a reliable definition of remission, or sometimes even low disease activity, the group suggested replacing DAS28 as a measurement instrument to evaluate disease activity in RA clinical trials. Proposed alternatives included SDAI, CDAI and Boolean criteria. [less ▲]

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See detailRecommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia
Reginster, Jean-Yves ULg; Cooper, Cyrus; Rizzoli, René et al

in Aging Clinical and Experimental Research (2016), 28(1), 47-58

Purpose: Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a ... [more ▼]

Purpose: Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a considerable social and economic burden. Potential treatments are under development but, as yet, no guidelines support regulatory studies for new drugs to manage sarcopenia. The objective of this position paper is therefore to suggest a set of potential endpoints and target population definitions to stimulate debate and progress within the medico-scientific and regulatory communities. Methods: A multidisciplinary expert working group was hosted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, which reviewed and discussed the recent literature from a perspective of clinical experience and guideline development. Relevant parallels were drawn from the development of definition of osteoporosis as a disease and clinical assessment of pharmaceutical treatments for that indication. Results A case-finding decision tree is briefly reviewed with a discussion of recent prevalence estimations of different relevant threshold values. The selection criteria for patients in regulatory studies are discussed according to the aims of the investigation (sarcopenia prevention or treatment) and the stage of project development. The possible endpoints of such studies are reviewed and a pleais made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia. Conclusions : The current lack of guidelines for the assessment of new therapeutic treatments for sarcopenia could potentially hinder the delivery of effective medicines to patients at risk. [less ▲]

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See detailPrevalence of concomitant bone and muscle wasting in patients from the SarcoPhAge Study
Locquet, Médéa ULg; Beaudart, Charlotte ULg; Reginster, Jean-Yves ULg et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 84

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See detailBrain-derived neurotrophic factor (BDNF) in normal healthy and hemodialyzed populations
CAVALIER, Etienne ULg; Carlisi, A.S.; WATAR, Florence ULg et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 116

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See detailPhysical and muscle performances among elderly nursing home residents. Results fo the senior cohort
Buckinx, Fanny ULg; Reginster, Jean-Yves ULg; CROISIER, Jean-Louis ULg et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 69

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See detailPrevalence of frailty among nursing home, according to different operational definitions
Buckinx, Fanny ULg; Reginster, Jean-Yves ULg; GILLAIN, Sophie ULg et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 69

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See detailEnglish translation and cross-cultural adaptation of the SARQOL Questionnaire
Beaudart, Charlotte ULg; Edwards, M.; Dennisson, E. et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 58

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See detailEffects of Dairy Products Consumption on Health: Benefits and Beliefs-A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
Rozenberg, Serge; Body, Jean-Jacques; Bruyère, Olivier ULg et al

in Calcified Tissue International (2016), 98(1), 1-17

Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes ... [more ▼]

Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health. [less ▲]

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See detailEfficacy and safety of hyaluronic acid in the management of osteoarthritis : Evidence from real-life setting trials and surveys.
Maheu, E.; Rannou, F.; Reginster, Jean-Yves ULg

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 28-33

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends intra-articular (IA) hyaluronic acid (HA) for management of knee ... [more ▼]

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends intra-articular (IA) hyaluronic acid (HA) for management of knee osteoarthritis (OA) as second-line treatment in patients who remain symptomatic despite use of non-steroidal anti-inflammatory drugs (NSAIDs). This recommendation is based upon accumulating evidence that IA HA provides a significant benefit in knee OA. There is good evidence that IA HA injections reduce pain and increase function in knee OA, and the benefits are long-lasting as compared with IA corticosteroids. Evidence from real-life studies of repeat courses of IA HA demonstrates an improvement in pain or function lasting up to 40 months (12 months after the last injection cycle), a reduction in use of concomitant analgesia by up to 50%, and suggests that there may be a delay in the need for total knee replacement (TKR) of around 2 years. The clinical benefit of IA HA on knee OA may be 2-fold: (i) mechanical viscosupplementation of the joint (allowing lubrication and shock absorption) and (ii) the re-establishment of joint homeostasis through induction of endogenous HA production, which continues long after the exogenous injection has left the joint.The magnitude of the clinical effect may be different for different HA products, but this has not been proven so far and requires further investigation. IA HA injections are generally considered to be safe,although a slightly higher number of cases of local reactions and post-injection non-septic arthritis has been reported with high molecular weight cross-linked HAs. The use of IA HA in knee OA patients with mild–moderate disease, and for more severe patients wishing to delay TKR surgery,is recommended by the ESCEO taskforce. Further investigation into the OA patient types most likely to benefit from IA HA is warranted. Viscosupplementation with IA HA is a safe and effective component of the multi-modal management of knee OA. [less ▲]

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See detailThe role of diet and exercise and of glucosamine sulfate in the prevention of knee osteoarthritis: Further results from the PRevention of knee Osteoarthritis in Overweight Females (PROOF) study.
Runhaar, J.; DEROISY, Rita ULg; van Middelkoop, M. et al

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 42-48

Background and objectives: The PRevention of knee Osteoarthritis in Overweight Females(PROOF) study (ISRCTN42823086) described a trend for a decrease in the incidence of kneeo steoarthritis (OA) by a ... [more ▼]

Background and objectives: The PRevention of knee Osteoarthritis in Overweight Females(PROOF) study (ISRCTN42823086) described a trend for a decrease in the incidence of kneeo steoarthritis (OA) by a tailored diet and exercise program (DEP)or by oral glucosamine sulfate in women at risk for the disease, using a composite clinical and/or radiological outcome. The aim of this updated post-hoc analysis was to re-assess the results according to more precise techniques and take advantage of the 2 x 2 factorial design. Methods: A total of 407 overweight( BMI > or egal 27kg/m2) women of 50–60 years of age with no diagnosis of knee OA were randomized to: (1) noDEP + placebo(Control, N = 102), (2) DEP + placebo (DEP, N = 101), (3) glucosamine sulfate + no DEP (GS, N = 102), and (4) DEP + glucosamine sulfate (DEP + GS, N = 102) and followed for 2.5 years, with standardized postero-anterior, semiflexed (MTP) view knee radiographs at baseline and end of the study. DEP consisted of a tailored low fat and/or low caloric diet and easy to implement physical activities. Glucosamine was given as oral crystalline glucosamine sulfate 1500 mg once daily ,double-blinded vs. placebo. Incident knee OA was defined as radiographic progression of >1mm minimum joint space narrowing (mJSN)in the medial tibiofemoral compartment, as previously assessed by the visual (manual) technique and by a new semi-automated method. Logistic regression analysis was used t ocalculate the odds ratio for the effect of the interventions. Results: After 2.5 years, 11.8% of control subjects developed knee OA. This incidence was decreased with glucosamine sulfate, either alone or in combination with the DEP, but not by the DEP alone. Since there was no statistical interaction between treatments, the 2x2 factorial design allowed analysis of patients receiving glucosamine sulfate (N = 204) vs. those not receiving it (N= 203), similarly for those on the DEP (N = 203) or not (N = 204). Glucosamine sulfate significantly decreased the risk of developing knee OA: odds ratio (OR) = 0.41(95% CI: 0.20–0.85, P = 0.02) by the manual JSN assessment method and OR = 0.42 (95% CI:0.20–0.92, P =0.03) by the semi-automated technique. Conversely, there was no decrease in risk with the DEP. Conclusions: Glucosamine sulfate decreased the risk of developing radiographic knee OA over 2.5 years in overweight, middle-aged women at risk, as determined by medial mJSN progression. Conversely a tailored diet and exercise program exerted no preventive effect, possibly because of the lower than expected effect on weigh tloss. [less ▲]

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See detailOptimizing the management of osteoarthritis-Transitioning evidence-based guidelines into practical guidance for real-world clinical practice
Reginster, Jean-Yves ULg; Cooper, C.

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 1-2

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See detailEfficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys.
Bruyère, Olivier ULg; Altman, R.D.; Reginster, Jean-Yves ULg

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 12-17

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends chronic symptomatic slow-acting drugs for osteoarthritis (SYSADOAs ... [more ▼]

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm recommends chronic symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) including glucosamine sulfate (GS) and chondroitin sulfate (CS) as first-line therapy for knee osteoarthritis (OA). Numerous studies are published on the use of SYSADOAs in OA; however, the efficacy of this class is still called into question largely due to the regulatory status, labeling and availability of these medications which differ substantially across the world. Examination of the evidence for the prescription patented crystalline GS (pCGS) formulation at a dose of 1500 mg once-daily demonstrates superiority overother GS and glucosamine hydrochloride (GH) formulations and dosage regimens. Thus, the ESCEO task force advocates differentiation of prescription pCGS over other glucosamine preparations. Long-term clinical trials andreal-life studies show that pCGS may delay joint structural changes, suggesting potential benefit beyond symptom control when used early in the management of knee OA. Real-life pharmacoeconomic studies demonstrate a long-term reduction in the need for additional pain analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) with pCGS, with a significant reduction of over 50% in costs associated with medications, healthcare consultations and examinations over 12 months. Furthermore, treatment with pCGS for at least 12 months leads to a reduction in the need for total joint replacement for at least 5 years following treatment cessation. Thus, pCGS(1500 mg od) is a logical choice to maximize clinical benefit in OA patients, with demonstrated medium-term control of pain and lasting impact on disease progression. [less ▲]

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See detailA 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.
Bruyère, Olivier ULg; Cooper, C.; Pelletier, J.P. et al

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 3-11

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 ... [more ▼]

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 step2 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, thes low titration of sustained-release tramadol, aweak opioid, affords sustained analgesia with improved tolerability. [less ▲]

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See detailA 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.
Bruyère, Olivier ULg; Cooper, C.; Pelletier, J.P. et al

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 3-11

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 ... [more ▼]

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 step2 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, thes low titration of sustained-release tramadol, aweak opioid, affords sustained analgesia with improved tolerability. [less ▲]

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See detailA 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.
Bruyère, Olivier ULg; Cooper, C.; Pelletier, J.P. et al

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 3-11

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 ... [more ▼]

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 step2 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, thes low titration of sustained-release tramadol, aweak opioid, affords sustained analgesia with improved tolerability. [less ▲]

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See detailA 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.
Bruyère, Olivier ULg; Cooper, C.; Pelletier, J.P. et al

in Seminars in Arthritis & Rheumatism (2016), 45(4 Suppl), 3-11

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 ... [more ▼]

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 step2 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, thes low titration of sustained-release tramadol, aweak opioid, affords sustained analgesia with improved tolerability. [less ▲]

Detailed reference viewed: 27 (12 ULg)