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Archive for July, 2010

This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

glucosamine and chondrotin

Recommendation XIX

In patients with symptomatic knee OA glucosamine sulphate and chondrotin sulphate may have structure-modifying effects.

Two randomized controlled trials involving 414 patients reported evidence that 1500mg of glucosamine sulphate taken on a daily basis may have structure-modifying effects in patients with knee OA.  This means cartilage may be rebuilt.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 41%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.




This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

glucosamine and chondroitin

Recommendation XVIII

Glucosamine and Chondroitin sulphate may be effective in providing symptomatic pain relief in patients with knee osteoarthritis.

Analysis of eight randomized controlled trials involving 755 patients reported moderate pain reduction.  However with so many products on the market with varying purity levels of glucosamine and chondroitin there is significant controversy as to the efficacy of this treatment option for knee osteoarthritis.

No adverse effects are reported from long-term use of glucosamine and chondroitin.  However if no response is apparent within 6 months treatment should be discontinued.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 63%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Hyaluronate Injection

Intra-articular injections of hyaluronate may be useful in patients with hip and knee osteoarthritis.

Hyaluronate is characterized by delayed onset, but it works longer for symptomatic pain relief when compared to injections of corticosteroids.  Injections of hyaluronate in the knee supplement existing synovial fluid with gel-like substances.

A comprehensive industry-sponsored review of 40 placebo-controlled trials involving viscosupplementation found improvements in pain.  No major safety issues were detected but adverse events such as transient pain at the injection site were reported.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 64%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

corticosteroid

Recommendation XVI

Intra-articular injections with corticosteroids should be considered to treat hip and knee osteoarthritis  when patients have moderate to severe pain and they are not responding to oral pain relievers and/or anti-inflmmatory agents.

Corticosteroid injections have been used to treat knee osteoarthritis for over 50 years.  It was recommended in 11 out of 13 existing guidelines.  The efficacy of intra-articular injections is well documented as a treatment for knee osteoarthritis.  Patients with knee OA were studied in 28 controlled trials and rarely were negative side effects reported.

Most experts do not recommend more than 4 corticosteroid injections per year.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 78%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

topical-NSAID

Topical NSAID

Recommendation XV

Topical NSAIDs and capsaicin can be effective when used in conjunction with oral pain relievers and anti-inflammatories in knee osteoarthritis.

In 13 randomized controlled trials topical NSAIDs were better than placebo in relieving pain and stiffness and in improving function in patients with knee OA.  Also 7 out of 9 existing guidelines recommended the use of topical NSAIDs.

Capsaicin creams contain an extract from chili peppers.  Evidence supports the use of capsaicin cream but 40% of patients are troubled with burning, stinging, or erythema.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 85%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Non-Steroidal Anti-Inflammatory Drug

Recommendation XIV

Non Steroidal Anti Inflammatory (NSAIDs) drugs should be used at the lowest effective dose but their long-term use should be avoided.

  • There is evidence that NSAIDs can be effective in reducing pain in patients with osteoarthritis of the knee and hip.
  • Evidence exists that NSAIDs are superior to acetaminophen for pain relief in patients with OA.
  • There is a lot of evidence that NSAIDs are associated with more adverse effects than acetaminophen
  • NSAIDs can cause serious gastrointestinal problems, such as ulcers, perforations and bleeds
  • Prescribers and patients should continue to use NSAIDs at the lowest effective dose for the shortest duration to control symptoms
  • Prescribers should not switch between NSAIDs without careful consideration of the overall safety profile of the products and te patient’s individual risk factors, as well as the patient’s preferences.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 93%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

acetaminophen

acetaminophen

Recommendation XIII

Acetaminophen or paracetamol can be an effective oral pain reliever for treatment of mild to moderate hip and knee osteoarthritis.

16 out of 16 guidelines examined by the research team recommend acetaminophen as a pain reliever.  Doses up to 4 grams per day is usually a first choice for mild to moderate pain relief.  However the safety and efficacy of long-term use can be dangerous.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 92%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

knee acupuncture

knee acupuncture

Recommendation XII

Acupuncture may benefit patients with knee OA.

Acupuncture is recommended as a treatment option for hip or knee osteoarthritis in 5/8 existing guidelines.  Also, seven randomized controlled trials were evaluated.  393 patients claimed that “real” acupuncture was more effective than “sham” acupuncture for pain relief.  However the findings in regards to function were inconclusive.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 59%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

TENS Unit

Recommendation XI

TENS Units (Transcutaneous Electrical Nerve Stimulation Units) can be effective for short-term pain relief in patients with hip and knee osteoarthritis.

8 out of 10 existing guidelines for the management of knee OA recommend TENS Units for pain relief.  The OARSi research team found that short-term (2-4 weeks) treatments are effective.  These results were confirmed by a systematic review of seven randomized controlled trials.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 58%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.


This is a continuation of our series on the Osteoarthritis Research Society International (OARSI) recommendations for the management of hip and knee osteoarthritis published in the Journal of Osteoarthritis and Cartilage.

Knee Therapy

Heat Therapy for Knee OA

Recommendation X

Some types of hot and cold therapy are effective at relieving symptoms in hip and knee osteoarthritis.

Hot and cold therapies are frequently used to treat symptoms in patients with hip and knee osteoarthritis.  They can include hot packs, cold packs, immersion in warm water, and ice massages.

Evidence supporting the use of these treatment options for knee osteoarthritis is limited.  One systematic review looked at two randomized controlled trials.  The results were that quadriceps strength was increased but the range of movement and walking was not effected in a statistically significant manner.

There have been no controlled trials with hot and cold therapy for patients with hip osteoarthritis.

The research team gave this osteoarthritis treatment option a Strength of Recommendation score of 64%.

W. Zhang Ph.D., Moskowitz M.D., et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. (2008) 16, 137-162.