Treatment of osteoarthritis

Czech version

Authors: K. Pavelka
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 20, 2012, No. 3, p. 138-157.
Category: Recommendation

Na základě dostupné evidence o účinnosti a po konsenzu členů výboru České revmatologické společnosti předkládá autor Doporučení České revmatologické společnosti pro léčbu osteoartrózy kolenních, kyčelních a ručních kloubů. V úvodní části práce jsou analyzovány problémy, které je nutno vyřešit před stanovením léčebného plánu u každého pacienta: správná diagnóza osteoartrózy, klasifikace osteoartrózy (primární, sekundární, monoartikulární, polyartikulární, generalizovaná), typ bolesti u nemocného, intenzita a frekvence bolesti, funkční omezení, strukturální poškození kloubu, rychlost progrese degenerativních změn, další onemocnění pacienta, jaké léky užívá a jejich možné interakce. Základní cíle při léčbě osteoartrózy jsou: zmenšit kloubní bolest a ztuhlost, zlepšit nebo alespoň zachovat kloubní mobilitu, zlepšit fyzické funkce, zmírnit hendikep, zlepšit na zdraví závislou kvalitu života, zpomalit progresi kloubní destrukce a vzdělat pacienta o povaze jeho nemoci a její léčbě. Léčebný plán by měl být navržen individuálně pro každého pacienta.

Overview

The author presents the recommendations of the Czech Society for Rheumatology for the treatment of osteoarthritis of the knee, hip and hand joints based on the available evidence on efficacy and consensus of the committee of the Czech Society for Rheumatology. In the introductory part of the report the problems that must be resolved before determining a treatment plan for each patient are analyzed: the correct diagnosis of osteoarthritis, osteoarthritis classification (primary, secondary, monoarticular, polyarticular or generalized), the type, intensity and frequency of pain, functional limitations, structural joint damage, rate of progression of degenerative changes, another diseases of the patient, the use of medication and their possible interactions. The basic goals in the treatment of osteoarthritis include: reduction of pain and stiffness of the joint, improvement or at least maintenance of joint mobility, improvement of physical function, alleviation of disability, improvement of health-dependent quality of life, retardation of the progression of joint destruction and education of the patient about the nature of his illness and its treatment. The treatment plan should be designed individually for each patient. Optimal care is provided by several experts, in addition to a rheumatologist, a patient with osteoarthritis should be also treated by a physical therapist, orthopedic surgeon, internist and obesitologist if needed. Each patient should be treated comprehensively. Complex treatment of osteoarthritis consists of non-pharmacological treatment, pharmacological therapy and surgery if needed. Evidence-based non-pharmacological methods of treatment include patient education, lifestyle modification (weight reduction, modification of biomechanical ratios), regular exercise, some means of physical therapy and the use of prosthetic and support devices. Pharmacological treatment with evidence-based effectiveness comprise paracetamol, systemically and locally administered NSAIDs, strong and weak opioids, intra-articular glucocorticoids and some symptomatic slow-acting drugs in osteoarthritis (SYSADOA – glucosamine sulfate, diacerein, an avocado and soy extract, chondroitin sulfate and hyaluronic acid). The surgical procedures with evidence-based effectiveness include replacement of hip and knee joints, both total and unicompartmental. There is no clear evidence on the effectiveness of arthroscopic procedures such as joint lavage and debridement. Osteotomy is recommended for osteoarthritis of the hip, especially in patients with dysplasia. Osteotomy in osteoarthritis of knee joints is not included in the new EULAR recommendations. In OA of the hand joints, there is a direct evidence of effectiveness for education and exercise, NSAIDs, COX-2 inhibitors, local NSAIDs and capsaicin, and chondroitin sulfate. Acetaminophen, glucosamine and local glucocorticoids were recommended upon extrapolation from other sites.

Key words:
osteoarthritis, pharmacological treatment, total joint replacemtent

Sources

1. Dawson J, Linsell L, Zondervan K, et al. Epidemiology of hip and knee pain and its impact on overall health status in older adults. Rheumatology 2004;43:497-504.

2. Altmann RD, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 1986;29:1039-1049.

3. Zhang W, Doherty M, et al. EULAR evidence based recommendations for the diagnoses of the OA. Ann Rheum Dis 2010;69:483-489.

4. Bellamy N, Buchannan WW, Goldsmith CH. Validation study of WOMAC. General Rheum 1988;15:1833-40.

5. Zhang W, Doherty M, Arden N, et al. EULAR recommendations: an evidence based medicine approach to the management of hip osteoarthritis. Report of task force of ESCISIT. Ann Rheum Dis 2005;64:669-81.

6. Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part bII. OARSI evidence based, expert consensus guidelines. Osteoarthr Cartil 2008;16:137-162.

7. Van der Esch M, Heimans M, Dekker J. Factors contributing to the possession and use of walking aids among patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 2003;49:838-842.

8. Brouwer RW, Jakma TS, Verhjagen AP, et al. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev Jan 2005;25/1/ CD004020

9. Roddy E, Zhang W, Doherty M, et al. Aerobic walking exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis 2005;64:544-8.

10. Hernandez-Molina G, Reichenbach S, Bin Z, et al. Effect of therapeutic exercise for hip osteoarthritis pain: results of metaanalysis. Arthritis Care Res 2008;59:1221-1228.

11. Bartels EM, Lund H, Hagen KB, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Sy Rev 2007;CD 005523.

12. Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis Part III. changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 2010;18:476-499.

13. Brosseau L, Yonge KA, Robinson NV, et al. Thermotherapy of treatment of osteoarthritis. Cochrane Database Syst Rev 2003;4:CD004522.

14. Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment of osteoarthritis of the knee. Am J Acupunct 1999;27:133-40.

15. Mc Carthy CJ, Callghan MJ, Oldham JH, et al. Pulsed electromagnetic energy treatment offers no clinical bendit in reducing the pain of knee osteoarthritis: a systematic review. BMC Musculoscelet Disord 2006;51.

16. Manheimer E, Linde K, Lao I, et al. Metaanalysis: acupuncture for osteoarthritis of the knee. Ann Intern Med 2007;146:868-77.

17. Bjordal JM, Johnson MI, Lopes-Martins RAB, et al. Short term efficacy of physical intervention of osteoarthritis knee pain. A systematic review and meta-analysis of randomised, placebo controlled trials. BMC Musculoscelet Disord 2007;8:51,doi: 101186/1471-2474/8/51l.

18. Towheed TE, Maxwell IL, Judd MG, et al. Acetaminophen for osteoarthritis. Cochrane Libr Oxford/2002;4:ID CD 004257.

19. Towheed TE, Maxwell IL, Judd MG, et al. Acetaminophen for osteoarthritis. Cochrane DATABASE Syst Rev 2006;1:CD 004257.

20. Rahme E, Barkun A, Nedjar H, et al. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebeck. Canada Am J Gastroenterol 2008;103:872-82.

21. FDA. Drug safety information http:www.fda.gov/ /Drugs/Drug Safety/information by drug class/ucm165107.htm:2009.

22. Bjordal JM, Ljungren AE, Klovning A, et al. Non-steroidal antiinflammatory drugs, including cyclooxygenase-2 inhibitors in osteoarthritis knee pain: meta-analysis of randomised placebo controlled trials. BMJ 2004;329:1317-20.

23. Bjordal JM, Klovning A, Ljungren AE, et al. Short term efficacy of pharmacotherapeutic innervations in osteoarthritis knee pain: a metaanalysis of randomised placebo controlled trials. Eur J Pain 2007;11: 125-38.

24. Zhang W, Jones A, Doherty M, et al. Does paracetamol reduce the pain of osteoarthritis? A metaanalysis of randomised controlled trials. Ann Rheum Dis 2004;63:901-907.

25. Ofman JJ, MacLean CH, Straus WL, et al. A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol 2002; 29:804-812.

26. Rahme E, Barkun A, Nedie H, et al. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec. Canada, Am J Gastroenteroll 2008;103:872-82.

27. Chan FK, Wong VW, Suen BY, et al. Combination of cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for preventive of recurrent ulcer bleeding in patients at very high risk: A double-blind, randomised trial. Lancet 2007;369:1621-6.

28. Rahme E, Barkun AN, Touboti Y, et al. Do proton pump inhibitors confer additional gastrointestinal protection in patients given celekoxib? Arthritis Rheum 2007;57:748-55.

29. Latimer N, Lord J, Grant RL, et al. Cost effectiveness of COX-2 selective inhibitors and traditional NSAIDs alone or in combination with a proton-pump inhibitor for people with osteoarthritis. BMJ 2009;339:b 2538.

30. Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenase inhibitors and traditional non steroidal anti-inflammatory drugs increase the risk of atherotrombosis? Meta-analysis of randomised trials. BMJ 2006;332:1302-1308.

31. EMEA/CHMP410051/2006.

32. Lin J, Zhang W, Jones A, et al. Efficacy of topical NSAIDs in the treatment of osteoarthritis: a metaanalysis of randomised controlled trials. Chin J Evid Based Med 2005;5:667-674.

33. Biswal S, Medhi B, Panhi P, et al. Long-term efficacy of nonsteroidal antiinflammatory drugs in knee OA: metaanalysis of randomized placebo controlled trials. J Rheumatol 2006;33:1841-1844.

34. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical kapsaicin: A double - blind trial. Clin Ther 1991;13:383-96.

35. Avouac J, Gossec L, Dougados M. Efficacy and safety of opioids for osteoarthritis: a metaanalysis of randomized, controlled trials. Osteoarthr Cartil 2007;15:957-965.

36. Pavelka K, Loet LX, Bjorneboe O, Herrero-Beuamont G, Richarz U. Benefits of transdermal fentanyl in patients with rheumatoid arthritis or with osteoarthritis of the knee or hip: an open-label study to assess pain control. Current Medical Research and Opinion 2004; Vol. 20, 12: 1967-1977.

37. Persiani S, Rotinin R, Trisolino G, et al. Synovial and plasma concentrations in osteoarthritis patients following crystaline glucosamine sulphate at therapeutic dose. Osteoarthr Cartil 2007;15:764-772.

38. Towhead TE, Maxwell, Ana stassiades TP, et al. Glucosamine therapy for treating osteoarthritis .The Cochrane Libr /Oxford/ 2005;4:IDCD002946.

39. Clegg D, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulphate and the two in combination for painful knee osteoarthritis. N Engl J Med 2006;354:795-808.

40. Herrero-Beaumont G, Roman Ivora JA, del Carmen Trabado MC, et al. Glucosamine sulphate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum 2007;56:555-567.

41. Wandel S, Juni P, Tendal B, et al. Effects of glucosamine, chondroitin, or placebo with osteoarthritis of hip or knee: network meta-analysis BMJ 2010;341:c4675 doi:10.10.1136/bmj.c.4675.

42. Reginster Y, Dereoisy R, Rovatti LC, et al. Long- term effects of glucosamine sulphate on osteoarthritis progression: a randomized, placebo controlled clinical trial. Lancet 2001;357:251-6.

43. Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulphate use and delay of progression of knee osteoarthritis. Arch Intern Med 2002;162:2113-23.

44. Moldovan F, Pelletier JP, Jolicoeur FC, et al. Diacerein and rhein ruduce the ICE –induced IL-1β and IL 18 activation in human osteoarthritis cartilage cultures. Osteoarthr Cartil 2000;8:186-196.

45. Smith GN, Myers SL, Brandt KD, et al. Diacerein treatment reduces the severity of osteoarthritis in the canine cruciate-deficiency model of osteoarthritis. Arthritis Rheum 1999;42:545-54.

46. Pelletier JP, Yaron M, Harauuai B, et al. Diacerein study group .Efficacy and safety of diacerein in osteoarthritis of the knee: a double-blind, placebo controlled trial. Arthritis Rheum 2000;43:2339-48.

47. Pavelka K, Trč Tomáš, Karpaš K, et al. The efficacy and safety of diacerein in the treatment of painful osteoarthritis of the knee. Arthritis Rheum. 2007;56:4055-4064.

48. Rintelen B, Neumann K, Leeb B. A metaanalysis of controlled clinical studies with diacerein in the treatment of osteoarthritis. Arch Intern Med 2006;1661899-1906.

49. Fidelix TSA, Soares BGDO, Trevisani VFM, et al. Diacerein for osteoarthritis (Cochrane Review). The Cochrane database of Systemic Reviews 2006, Issue 1. Arit No:CD005117.

50. Dougados M, Nguyen M, Berdah L, et al. Evaluation of the structure modifying effects of diacerein in hip osteoarthritis. ECHODIAH: a three year placebo-controlled trial. Arthritis Rheum 2001;44:2539-47.

51. Mauviel A, Daireaux M, Hartmann D, et al. Effects des insaponifables diavocat et da soja sur la production de collagene par des cultures de synoviocytes, chondrocytes articulares et fibroblastes dermiques. Mal Osteoartic 1989;56:207-211.

52. Kawczak CE, Frisbie DD. Mc Ilwright CW, et al. Evaluation of avocado and soya been unsaponifables extracts for treatment of horses with experimentally induced osteoarthritis. Am J Vet Res 2007;68:598-604.

53. Boumediene K, Felisaz N, Bogdanowicz P, et al. Effects of free avocado soyabean insaponifables mixtures on metaloproteinases, cytokines and prostagalandins E 2 production by human articular chondrocytes. Clin Rheumatol 1998;17:31-39.

54. Maheu E, Valat JP, et al. Symtomatic efficacy of avocado/soya bean unsaponifables in the treatment of the osteoarthritis of knee and hip: a prospective, randomized, double blind, placebo controlled, multicenter clinical trial with a six-months follow up demonstrative a persistent effect. Arthritis Rheum 1998;41:81-91.

55. Appelboom T, Schuermans J, Verbruggen G, et al. Symptoms modifying effect of avocado/soyabean unsaponifables (ASU) in knee osteoarthritis. Scand J Rheumatol 2001;30:242-7.

56. Christensen P, Bartels EM, Astrup A, et al. Symptomatic efficacy of avocado-soybean unsaponifables (ASU) in OA patients: a metaanalysis of randomized, controlled trials. Osteoarthr Cartil 2007;29,doi: 10.1016/j.joca.2007.10.003.

57. Maheu E, Cadet C, Marty M, et al. Evaluation of the structure modifying effect of ASU in hip OA. Results of ERADIAS study. A 3 year prospective, randomized, double blind, placebo controlled trial. Osteoarthr Cartil 18:(Suppl.2):560.

58. Monfort J, Pelletier JP, Garcia-Giralt N, et al. Biochemical basis of the effect of chondroitin sulfate on osteoarthritis articular tissues. Ann Rheum Dis 2007 as 10.1136/ard.2006.068882.

59. Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003;163:1514-1522.

60. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006Ost;364:795-808.

61. Gabay C. Symptomatic effects of chondroitin 4 an chondroitin 6 sulfate on hand osteoarthritis: a randomized, double blind, placebo controlled clinical trial at a single center. Arthritis Rheum 2011;63:3383-3391.

62. Kahan A, Uebelhart D, Fathaire F, et al. Long term effects of chondroitin 4 and 6 sulphate on knee osteoarthritis. The study on osteoarthritis progression preventive, a two - year, randomized double blind, placebo controlled trial. Arthritis Rheum 2009;60:524-533.

63. Ghosh P. The role of hyaluronic acid (hyaluronan) in health and disease: interactions with cells, cartilage and components of synovial fluid. Clin Exp Rheumatol 1994;12:85-87.

64. Bellamy N, Campbell J, Robinson V, et al. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006;April19 th/2/:CD005321.

65. Bannuru RR, Natov NS, Obadan IE, et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and metaanalysis. Arthritis Care Res 2009;61:1704-1711.

66. Lo GH, Lavalley M, Felson DT. Intraarticular hyaluronic acid in the treatment of knee osteoarthritis: A metaanalysis. JAMA 2003;290:3115-21.

67. Reichenbach S, Blank, Rutjes AW, et al. Hylan versus hyaluronic acid for osteoarthritis of the knee a systematic review and metaanalysis. Arthritis Rheum 2007;57:1410-1408.

68. Jubb RW, Piva M, Beinat L, et al. A one year, randomized trial of 500-730 kDa sodium hyaluronate on the radiological stage of osteoarthritis of the knee. Inter J Clin Practise 2003;57:1-8.

69. Pavelka K, Uebelhart D. Efficacy of highly purified intraarticular hyaluronic acid (Synovial) vs. hylan G-F20 (Synvisc) in the treatment of symptomatic knee osteoarthritis. A double blind, controlled, randomized, parallel-group non- inferiority study Osteoarthr Cartil doi:10. 1016/j.joca.2011.07.016.

70. Fitzpatrick R, Shortall E, Sculpher M, et al. Primary total hip replacement Summary: a systematic review of outcomes and modelling of cost–effectiveness associated with different prostheses. Health Technol Asssessss.1998;2:1-4.

71. Rand JA, Trousdale RT, Ilstrup DM, et al. Factors affecting the durability and primary total knee prostheses. J Bone Joint Surg Am 2003;85:259-65.

72. Rasanen P, Paavolainen P, Sintonen H, et al. Effectiveness of hip or knee replacement Summery in term soft quality-adjusted life years and cost. Acta Orthop 2007;78:108-15.

73. Siparsky P, Ryzewicz M, Peterson B, et al. Arthroscopic treatment of osteoarthritis of the knee: are there any evidence –based indications? Clin Orthop Relat Res 2007;455: 107-112.

74. Koulovaris P, Stafylas K, Aznaoutoglou C, et al. Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long term results. Int Orthop (SICOT) 2007;31:193-198.

75. Virolainen P, Aro HT High tibial osteotomy for the treatment of osteoarthritis of the knee: a review of the literature and a metaanalysis of follow up studies. Arch Orthop Trauma Surg 2004;124:258-61

76. Scott JC, Hochberg MC. Osteoarthritis: I. Epidemiology. Md State Med J 1984;33:712-716.

77. Jones G., Cooley HM., Bellamy N. A cross-sectional study of the association between Heberdenęs nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain. Osteoarthritis Cart. 2001;9:606-611.

78. Altman RD, Alarcom G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum. 1990;33:1601-1610.

79. Towheed TE. Systematic review of therapies for osteoarthritis of the hand. Osteoarthritis Cart. 2005;13:455-462.

80. Zhang W, Doherty M, Leeb B, et al. EULAR evidence based recommendations for the management of hand osteoarthritis – report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis 2007; 66: 377-388.

81. Stamm TA, Machold KP, Smolen JS, et al. Joint protection and home hand exercises improve hand function in patients with hand OA: a randomized, controlled trial. Arthritis Care Res 2002;47:44-49.

82. Brosseau L, Judd MG, Marchand S, et al. Thermo therapy for treatment of ostearthritis. The Cochrane Database of Systemic Reviewes: Reviews 2003; Issue 4, John Wiley and sons, Ltd. Chichester, UK DOI: 10 1002/ /14651858C 2003.

83. Weiss S, Lastayo P, Mills A, et al. Splinging the degenerative basal joint: custom- made or prefatricated neoprene? J Hand Ther 2004;17:401-406.

84. Lin J, Zhang W, Jones A, et al. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: meta-analysis of randomised controlled trials. BMJ 2004;329:324.

85. Mccarthy GM, Mccarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 1992;19:604-7.

86. Schnitzer T, Morton C, Coker S. Topical capsaicin therapy for osteoarthritis pain: achieving a maintenance regimen. Semin Arthritis Rheum 1994;23:34-40.

87. Seiler V. Meclofenamate sodium in the treatment of degenerative joint disease of the hand (Heberden nodes). Arzneimittel-Forsch 1983;33:656-9.

88. Verbruggen G, Goemaere S, Veys EM, et al. Systems to assess the progression of finger joint osteoarthritis and the effects of disease modifying osteoarthritis drugs. Clin Rheumatol 2002;21:231-43.

89. Gabay C, Medinger-Sadowski C, Gascon D, et al. Symptomatic Effects of Chondroitin 4 and Chondroitin 6 Sulfate on Hand Osteoarthritis. Arthritis Rheum 2011; 63(11):3383-3391.

90. Fuchs S, Monikes R, Wohlmeiner A, et al. Intra-articular hyaluronic acid compared with corticoid injecions for the treatment of rhizarthrosis. Osteoarthritis Cartilage 2006;14:82-8.

91. Joshi R. Intraarticular corticosteroid injection for first carpometacarpal osteoarthritis. J Rheumatol 2005;32:1305-6.

92. Wajon A, Ada L, Edmunds I, et al. Surgery for thumb osteoarthritis. The Cochrane Database of Systemic Reviews: Review 2005, Issue 4, John Wiley and Sons, Ltd. Chichester, UK DOI:10 1002/14651858 CD 004631 pub 2 2005.

Labels

Dermatology & STDs Paediatric rheumatology Rheumatology Surgery Orthopaedics General practitioner for adults

Multiorgan failure and macrophage activation syndrome in adult-onset Still´s disease

Article was published in

Czech Rheumatology

2012 Issue 3