THE EUROPEAN SOCIETY FOR CLINICAL AND ECONOMIC ASPECTS OF OSTEOPOROSIS AND OSTEOARTHRITIS (ESCEO) ALGORITHM FOR THE MANAGEMENT OF KNEE OSTEOARTHRITIS IS APPLICABLE TO RUSSIAN CLINICAL PRACTICE: A CONSENSUS STATEMENT OF LEADING RUSSIAN AND ESCEO OSTEOARTHRITIS EXPERTS

Author:

Denisov L. N.1,Tsvetkova E. S.1,Golubev G. Sh.2,Bugrova O. V.3,Dydykina I. S.1,Dubikov A. I.4,Menshikova L. V.5,Peshekhonova L. K.6,Rebrov A. P.7,Torgashin A. N.8,Trofimov E. A.9,Yakupova S. P.10,Zonova E. V.11,Brewer O.12,Cooper C.13,Reginster J.14,Knyazeva L. A.15

Affiliation:

1. V.A. Nasonova Research Institute of Rheumatology

2. Rostov State Medical University, Ministry of Health of Russia

3. Orenburg State Medical University, Ministry of Health of Russia

4. Pacific State Medical University, Ministry of Health of Russia

5. Irkutsk State Medical Academy of Postgraduate Education

6. Railway Clinical Hospital at the Voronezh-1 Station, OAO «RZhD»

7. V.I. Razumovsky Saratov State Medical University, Ministry of Health of Russia

8. N.N. Priorov Central Research Institute of Traumatology and Orthopedics, Ministry of Health of Russia

9. I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia

10. Kazan State Medical University, Ministry of Health of Russia

11. Railway Clinical Hospital at the Novosibirsk-Main Station, OAO «RZhD»

12. Epidemiology, and Health Economics, Centre Hospitalier Universitaire in Sart-Tilman, Universite de Liege

13. MRC Lifecourse Epidemiology Unit, University of Southampton

14. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford

15. Kursk State Medical University, Ministry of Health of Russia

Abstract

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription 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 but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. 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.

Publisher

Mediar Press

Subject

Immunology,Immunology and Allergy,Rheumatology

Reference110 articles.

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