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BMC Musculoskeletal Disorders

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Open Access 01-12-2008 | Research article

Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system

Authors: Olivier Bruyère, Nansa Burlet, Pierre D Delmas, René Rizzoli, Cyrus Cooper, Jean-Yves Reginster

Published in: BMC Musculoskeletal Disorders | Issue 1/2008

Abstract

Background

Symptomatic slow-acting drugs (SYSADOA) have been largely studied over the last decade. The objective of this study is to prepare a document providing recommendations for the use of SYSADOA in osteoarthritis (OA).

Methods

The following interventions were taken into consideration: avocado/soybean unsaponifiables, chondroitin sulfate, diacereine, glucosamine sulfate, hyaluronic acid, oral calcitonin, risedronate, strontium ranelate. Recommendations were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The GRADE system is based on a sequential assessment of the quality of evidence, followed by assessment of the balance between benefits versus downsides and subsequent judgment about the strength of recommendations.

Results

Chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid have demonstrated pain reduction and physical function improvement with very low toxicity, with moderate to high quality evidence. Even if pre-clinical data and some preliminary in vivo studies have suggested that oral calcitonin and strontium ranelate could be of potential interest in OA, additional well-designed studies are needed.

Conclusion

In the benefit/risk ratio, the use of chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid could be of potential interest for the symptomatic management of OA.

Goldring SR, Goldring MB: Clinical aspects, pathology and pathophysiology of osteoarthritis. J Musculoskelet Neuronal Interact. 2006, 6 (4): 376-8.PubMed

Martel-Pelletier J, Lajeunesse D, Fahmi H, Tardif G, Pelletier JP: New thoughts on the pathophysiology of osteoarthritis: one more step toward new therapeutic targets. Curr Rheumatol Rep. 2006, 8 (1): 30-6. 10.1007/s11926-006-0022-6.CrossRefPubMed

Garstang SV, Stitik TP: Osteoarthritis: epidemiology, risk factors, and pathophysiology. Am J Phys Med Rehabil. 2006, 85 (11 Suppl): S2-11. 10.1097/01.phm.0000245568.69434.1a. quiz S12-4CrossRefPubMed

Arden N, Nevitt MC: Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006, 20 (1): 3-25. 10.1016/j.berh.2005.09.007.CrossRefPubMed

Jinks C, Jordan K, Croft P: Osteoarthritis as a public health problem: the impact of developing knee pain on physical function in adults living in the community: (KNEST 3). Rheumatology (Oxford). 2007, 46 (5): 877-81. 10.1093/rheumatology/kem013.CrossRef

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N: OARSI recommendations for the management of hip and knee osteoarthritis, Part I: Critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007, 15 (9): 981-1000. 10.1016/j.joca.2007.06.014.CrossRefPubMed

Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000, 43 (9): 1905-15. 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-P.

Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P: EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003, 62 (12): 1145-55. 10.1136/ard.2003.011742.CrossRefPubMedPubMedCentral

Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP: EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005, 64 (5): 669-81. 10.1136/ard.2004.028886.CrossRefPubMed

10.

Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW: 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 (3): 377-88. 10.1136/ard.2006.062091.CrossRefPubMed

11.

Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N: OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008, 16 (2): 137-62. 10.1016/j.joca.2007.12.013.CrossRefPubMed

12.

Altman RD, Zinsenheim JR, Temple AR, Schweinle JE: Three-month efficacy and safety of acetaminophen extended-release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage. 2007, 15 (4): 454-61. 10.1016/j.joca.2006.10.008.CrossRefPubMed

13.

Avouac J, Gossec L, Dougados M: Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2007

14.

Baker K, Goggins J, Xie H, Szumowski K, LaValley M, Hunter DJ: A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum. 2007, 56 (4): 1198-203. 10.1002/art.22516.CrossRefPubMed

15.

Batlle-Gualda E, Roman Ivorra J, Martin-Mola E, Carbonell Abello J, Linares Ferrando LF, Tornero Molina J: Aceclofenac vs paracetamol in the management of symptomatic osteoarthritis of the knee: a double-blind 6-week randomized controlled trial(1,2). Osteoarthritis Cartilage. 2007

16.

Brismee JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA: Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2007, 21 (2): 99-111. 10.1177/0269215506070505.CrossRefPubMed

17.

Cantarini L, Leo G, Giannitti C, Cevenini G, Barberini P, Fioravanti A: Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial. Rheumatol Int. 2007, 27 (6): 523-9. 10.1007/s00296-006-0266-5.CrossRefPubMed

18.

Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J: Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007, 57 (3): 407-14. 10.1002/art.22621.CrossRefPubMed

19.

Garland D, Holt P, Harrington JT, Caldwell J, Zizic T, Cholewczynski J: A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2007, 15 (6): 630-7. 10.1016/j.joca.2007.01.004.CrossRefPubMed

20.

Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M, Blanco FJ, Benito P, Martin-Mola E: Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum. 2007, 56 (2): 555-67. 10.1002/art.22371.CrossRefPubMed

21.

Karagulle M, Karagulle MZ, Karagulle O, Donmez A, Turan M: A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis: A 24-week randomised, controlled pilot study. Clin Rheumatol. 2007

22.

Kruger K, Klasser M, Mossinger J, Becker U: Oxaceprol – a randomised, placebo-controlled clinical study in osteoarthritis with a non-conventional non-steroidal anti-inflammatory drug. Clin Exp Rheumatol. 2007, 25 (1): 29-34.PubMed

23.

Lambert RG, Hutchings EJ, Grace MG, Jhangri GS, Conner-Spady B, Maksymowych WP: Steroid injection for osteoarthritis of the hip: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2007, 56 (7): 2278-87. 10.1002/art.22739.CrossRefPubMed

24.

Louthrenoo W, Nilganuwong S, Aksaranugraha S, Asavatanabodee P, Saengnipanthkul S, Thai Study G: The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study. Osteoarthritis Cartilage. 2007, 15 (6): 605-14. 10.1016/j.joca.2007.02.021.CrossRefPubMed

25.

McCarthy G, O'Donovan J, Jones B, McAllister H, Seed M, Mooney C: Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J. 2007, 174 (1): 54-61. 10.1016/j.tvjl.2006.02.015.CrossRefPubMed

26.

Puopolo A, Boice JA, Fidelholtz JL, Littlejohn TW, Miranda P, Berrocal A: A randomized placebo-controlled trial comparing the efficacy of etoricoxib 30 mg and ibuprofen 2400 mg for the treatment of patients with osteoarthritis. Osteoarthritis Cartilage. 2007

27.

Williamson L, Wyatt MR, Yein K, Melton JT: Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford). 2007

28.

Yurtkuran M, Alp A, Konur S, Ozcakir S, Bingol U: Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study. Photomed Laser Surg. 2007, 25 (1): 14-20. 10.1089/pho.2006.1093.CrossRefPubMed

29.

Brandt KD: A critique of the 2000 update of the American College of Rheumatology recommendations for management of hip and knee osteoarthritis. Arthritis Rheum. 2001, 44 (10): 2451-5. 10.1002/1529-0131(200110)44:10<2451::AID-ART416>3.0.CO;2-F. author reply 2455-6CrossRefPubMed

30.

Dieppe PA: Concerns about the methodology used in developing the 2000 update of the American College of Rheumatology recommendations for management of hip and knee osteoarthritis. Arthritis Rheum. 2001, 44 (10): 2450-1. 10.1002/1529-0131(200110)44:10<2450::AID-ART415>3.0.CO;2-L. author reply 2455-6CrossRefPubMed

31.

Zhang W, Doherty M: EULAR recommendations for knee and hip osteoarthritis: a critique of the methodology. Br J Sports Med. 2006, 40 (8): 664-9. 10.1136/bjsm.2004.016840.CrossRefPubMedPubMedCentral

32.

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S: Grading quality of evidence and strength of recommendations. Bmj. 2004, 328 (7454): 1490-10.1136/bmj.328.7454.1490.CrossRefPubMed

33.

Atkins D, Briss PA, Eccles M, Flottorp S, Guyatt GH, Harbour RT: Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res. 2005, 5 (1): 25-10.1186/1472-6963-5-25.CrossRefPubMedPubMedCentral

34.

Blotman F, Maheu E, Wulwik A, Caspard H, Lopez A: Efficacy and safety of avocado/soybean unsaponifiables in the treatment of symptomatic osteoarthritis of the knee and hip. A prospective, multicenter, three-month, randomized, double-blind, placebo-controlled trial. Rev Rhum Engl Ed. 1997, 64 (12): 825-34.PubMed

35.

Appelboom T, Schuermans J, Verbruggen G, Henrotin Y, Reginster JY: Symptoms modifying effect of avocado/soybean unsaponifiables (ASU) in knee osteoarthritis. A double blind, prospective, placebo-controlled study. Scand J Rheumatol. 2001, 30 (4): 242-7. 10.1080/030097401316909602.CrossRefPubMed

36.

Maheu E, Mazieres B, Valat JP, Loyau G, Le Loet X, Bourgeois P: Symptomatic efficacy of avocado/soybean unsaponifiables in the treatment of osteoarthritis of the knee and hip: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial with a six-month treatment period and a two-month followup demonstrating a persistent effect. Arthritis Rheum. 1998, 41 (1): 81-91. 10.1002/1529-0131(199801)41:1<81::AID-ART11>3.0.CO;2-9.CrossRefPubMed

37.

Leeb BF, Schweitzer H, Montag K, Smolen JS: A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000, 27 (1): 205-11.PubMed

38.

McAlindon TE, LaValley MP, Gulin JP, Felson DT: Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. Jama. 2000, 283 (11): 1469-75. 10.1001/jama.283.11.1469.CrossRefPubMed

39.

Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY: Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med. 2003, 163 (13): 1514-22. 10.1001/archinte.163.13.1514.CrossRefPubMed

40.

Reichenbach S, Sterchi R, Scherer M, Trelle S, Burgi E, Burgi U: Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007, 146 (8): 580-90.CrossRefPubMed

41.

Rintelen B, Neumann K, Leeb BF: A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis. Arch Intern Med. 2006, 166 (17): 1899-906. 10.1001/archinte.166.17.1899.CrossRefPubMed

42.

Fidelix TS, Soares BG, Trevisani VF: Diacerein for osteoarthritis. Cochrane Database Syst Rev. 2006, CD005117-1

43.

Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V: Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005, CD002946-2

44.

Vlad SC, LaValley MP, McAlindon TE, Felson DT: Glucosamine for pain in osteoarthritis: why do trial results differ?. Arthritis Rheum. 2007, 56 (7): 2267-77. 10.1002/art.22728.CrossRefPubMed

45.

Reginster JY: The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest. Arthritis Rheum. 2007, 56 (7): 2105-10. 10.1002/art.22852.CrossRefPubMed

46.

Reichenbach S, Blank S, Rutjes AW, Shang A, King EA, Dieppe PA: Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthritis Rheum. 2007, 57 (8): 1410-8. 10.1002/art.23103.CrossRefPubMed

47.

Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M: Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. Cmaj. 2005, 172 (8): 1039-43.CrossRefPubMedPubMedCentral

48.

Lo GH, LaValley M, McAlindon T, Felson DT: Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. Jama. 2003, 290 (23): 3115-21. 10.1001/jama.290.23.3115.CrossRefPubMed

49.

Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G: Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006, CD005321-2

50.

Wang CT, Lin J, Chang CJ, Lin YT, Hou SM: Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004, 86-A (3): 538-45.PubMed

51.

Modawal A, Ferrer M, Choi HK, Castle JA: Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005, 54 (9): 758-67.PubMed

52.

Medina JM, Thomas A, Denegar CR: Knee osteoarthritis: should your patient opt for hyaluronic acid injection?. J Fam Pract. 2006, 55 (8): 669-75.PubMed

53.

Manicourt DH, Azria M, Mindeholm L, Thonar EJ, Devogelaer JP: Oral salmon calcitonin reduces Lequesne's algofunctional index scores and decreases urinary and serum levels of biomarkers of joint metabolism in knee osteoarthritis. Arthritis Rheum. 2006, 54 (10): 3205-11. 10.1002/art.22075.CrossRefPubMed

54.

Bingham CO, Buckland-Wright JC, Garnero P, Cohen SB, Dougados M, Adami S: Risedronate decreases biochemical markers of cartilage degradation but does not decrease symptoms or slow radiographic progression in patients with medial compartment osteoarthritis of the knee: results of the two-year multinational knee osteoarthritis structural arthritis study. Arthritis Rheum. 2006, 54 (11): 3494-507. 10.1002/art.22160.CrossRefPubMed

55.

Spector TD, Conaghan PG, Buckland-Wright JC, Garnero P, Cline GA, Beary JF: Effect of risedronate on joint structure and symptoms of knee osteoarthritis: results of the BRISK randomized, controlled trial [ISRCTN01928173]. Arthritis Res Ther. 2005, 7 (3): R625-33. 10.1186/ar1716.CrossRefPubMedPubMedCentral

56.

Bruyere O, Delferriere D, Roux C, Wark JD, Spector T, Devogelaer JP: Effects of strontium ranelate on spinal osteoarthritis progression. Ann Rheum Dis. 2007

57.

Campbell J, Bellamy N, Gee T: Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hylan in osteoarthritis of the knee. Osteoarthritis Cartilage. 2007, 15 (12): 1424-36. 10.1016/j.joca.2007.01.022.CrossRefPubMed

58.

Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM: Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006, 354 (8): 795-808. 10.1056/NEJMoa052771.CrossRefPubMed

59.

Rozendaal RM, Koes BW, van Osch GJ, Uitterlinden EJ, Garling EH, Willemsen SP: Effect of glucosamine sulfate on hip osteoarthritis: a randomized trial. Ann Intern Med. 2008, 148 (4): 268-77.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/9/165/prepub

Title: Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system
Authors: Olivier Bruyère
Nansa Burlet
Pierre D Delmas
René Rizzoli
Cyrus Cooper
Jean-Yves Reginster
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2008
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-9-165

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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