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Adv Rheumatol ; 61: 7, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152749


Abstract Objectives: To compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA). Methods: In this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)—Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale—were randomized to receive GS/ CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use. Results: Mean reductions of WOMAC pain score were - 35.1 (sd = 23.2) mm in the GS/CS group and - 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the noninferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events. Conclusions: The new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile. Trial registration:; Registration number NCT02830919; Date of registration: July 13, 2016; First randomization date: December 05, 2016).(AU)

Humans , Chondroitin/therapeutic use , Osteoarthritis, Knee/drug therapy , Drug Combinations , Glucosamine/therapeutic use , Single-Blind Method , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-878964


To evaluate the efficacy and safety of Chinese patent medicine in the treatment of knee osteoarthritis(KOA) with network Meta-analysis, and provide evidence-based medicine evidences for clinical practice. PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and CBM were used to search for clinical randomized controlled trials(RCTs) on Chinese patent medicines for treatment of knee osteoarthritis, with a time limit from the establishment of each database to March 2020. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included RCTs. The network Meta-analysis was performed by Stata 14.0 software. A total of 5 788 patients in 58 RCTs were included, involving 9 kinds of Chinese patent medicines. The results of the network Meta-analysis indicated that in terms of total effective rate, the top three optimal medication regimens were Jinwu Gutong Capsules + Amino Acid Glucose(AAG), Xianling Gubao + AAG and Biqi Capsules; the top three interventions to reduce the VAS score were Panlongqi Tablets > Xianling Gubao + AAG > Xianling Gubao + non steroidal anti-inflammatory drugs(NSAIDs); the top three interventions to reduce the total score of WOMAC were Jintiange Capsules+NSAIDs> Jinwu Gutong Capsules + AAG > Biqi Capsules + NSAIDs; the top three medication schemes with better curative effect to reduce Lequesnse index were Xianling Gubao + NSAIDs > Biqi Capsules + NSAIDs > Jintiange Capsules + NSAIDs; the top three interventions to reduce TNF-α level Xianling Gubao + AAG > Jintiange Capsules > Jintiange Capsules + AAG=Jinwu Gutong Capsules + AAG. In terms of safety, the top five interventions with the least adverse reactions were Biqi Capsules > Jinwu Gutong Capsules > Biqi Capsules + NSAIDs > Xianling Gubao + NSAIDs > Jintiange Capsules. The combined application of Chinese patent medicine and NSADIs or AAG can improve the clinical treatment effect and reduce adverse reactions in KOA patients.

Biological Products , China , Drugs, Chinese Herbal , Humans , Network Meta-Analysis , Nonprescription Drugs , Osteoarthritis, Knee/drug therapy
Article in Chinese | WPRIM | ID: wpr-888159


Wangbi Tablets are widely used in the treatment of rheumatoid arthritis, knee osteoarthritis and other diseases at pre-sent. Long-term clinical application and research have shown that this drug has a good effect in reducing the pain of related diseases and improving symptoms. Due to the lack of guidance in the instructions and currently no relevant norms to guide the clinical application of Wangbi Tablets, in order to further improve clinicians' understanding of the drug and fully tap the clinical advantages of the drug, the Professional Committee of Orthopedics and Traumatology Drug Research of China Association of Chinese Medicine organized experts in the fields of rheumatism, orthopedics, pharmacy and methodology in Chinese and western medicine to develop expert consensus on Chinese patent medicines in accordance with the relevant requirements of the consensus methodology. Based on full consideration of clinical research evidence and expert experience, the clinical issues were summarized in the consensus, and for those clinical problems supported by evidences, the internationally recognized recommendation evaluation and formulation method GRADE was used to evaluate the evidence and form recommendations; for those clinical issues not supported by evidences, a consensus was reached through the nominal group method to form consensus recommendations. The consensus adopted a concise and clear format to form re-commendations or reach consensus suggestions on the medication regimen, medication characteristics, intervention timing, usage and dosage, course of use and safety issues for the treatment of rheumatoid arthritis and knee osteoarthritis with Wangbi Tablets. It is suggested that its application will better improve the efficacy of Wangbi Tablets in the treatment of rheumatoid arthritis and knee osteoarthritis, at the same time provide a reference for clinicians to use Wangbi Tablets in a standardized, reasonable and safe manner.

Arthritis, Rheumatoid/drug therapy , Consensus , Drugs, Chinese Herbal , Humans , Medicine, Chinese Traditional , Osteoarthritis, Knee/drug therapy , Tablets
Article in Chinese | WPRIM | ID: wpr-879456


OBJECTIVE@#To compare clinical effects of compound betamethasone and compound betamethasone with hyaluronic acid in treating moderate-severe knee osteoarthritis (KOA).@*METHODS@#A prospective randomized controlled study was conducted in 116 patients with unilateral moderate-severe KOA patients from February 2017 to November 2017 and divided into observation group and control group, 58 patients in each group. In observation group, there were 15 males and 43 females aged from 45 to 80 years old with an average of (66.45±6.31) years old;according to Kellgren-Lawrence(K-L) classification, 42 patients were type Ⅲ and 16 patients were type Ⅳ;the courses of disease ranged from 4 to 8 years with an average of (5.25±2.21) years;the patients were treated by injecting 1 ml compound betamethasone into knee joint. In control group, there were 13 males and 45 females aged from 45 to 80 years old with an average of (64.89±6.41) years old;according to K-L classification, 43 patients were type Ⅲ and 15 patients were type Ⅳ;the courses of disease ranged from 4 to 10 years with an average of (5.41±2.35) years;the patients were treated by knee joint injection of 4 ml hyaluronic acid and 1 ml compound betamethasone. Visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to evaluate clinical effects before treatment and 1 week, 1, month, 3 and 6 months after treatment.@*RESULTS@#Totally 55 patients in observation group were followed up for 6 months, and 3 patients were quit at 3 months after treatment for poor efficacy. Totally 56 patients in control group were followed up for 6 months, and 2 patients were withdrew from the follow-up on the first and third month respectively for poor efficacy. There were no statistical difference in VAS and WOMAC between two groups before treatment and different time points after treatment (@*CONCLUSION@#For patients with moderate-severe KOA, there is no significant difference in therapeutic effect between compound betamethasone injection and compound betamethasone combined with hyaluronic acid injection, and long-term effect of two methods is not good.

Betamethasone , Child , Child, Preschool , Female , Humans , Hyaluronic Acid , Injections, Intra-Articular , Male , Osteoarthritis, Knee/drug therapy , Prospective Studies , Treatment Outcome
Rev. ANACEM (Impresa) ; 14(1): 74-80, 2020.
Article in Spanish | LILACS | ID: biblio-1123589


INTRODUCCIÓN: La artrosis rodilla es una enfermedad crónica, degenerativa, inflamatoria y multifactorial que afecta el cartílago articular, provocando dolor y pérdida de funcionalidad. Actualmente, existen una variedad de nuevos fármacos y protocolos terapéuticos, generando dudas al momento del tratamiento. Por lo anterior, el objetivo de este trabajo es entregar una revisión de la literatura con información reciente, con el fin de brindar una recomendación actualizada para el manejo de la artrosis de rodilla. MATERIALES Y MÉTODOS: Se realizó una revisión no sistemática de estudios publicados entre enero del 2000 y agosto del 2020, utilizando los términos MeSH "knee", "osteoarthritis" y "therapeutics". Se usaron como motores de búsqueda PubMed, The Cochrane Library y Trip Data base, excluyendo estudios en animales y población pediátrica. DISCUSIÓN: Es importante destacar que independientemente de la modalidad de tratamiento, este debe ser escalonado e individualizado, pues cada paciente va a responder de forma diferente. Se recomienda en primer lugar los cambios de estilo de vida, autocuidado y educación. En segundo lugar, la kinesioterapia, seguido de la farmacología tópica y oral (AINES y paracetamol) y como última opción, el tratamiento intraarticular en base a corticoides. CONCLUSIÓN: El tratamiento de la artrosis de rodilla debe ser integral y centrado tanto en el manejo farmacológico como no farmacológico. Actualmente, no existe un único fármaco seguro, altamente útil y costo-efectivo para el tratamiento crónico

INTRODUCTION: Knee osteoarthritis is a chronic, degenerative, inflammatory, and multifactorial disease that affects joint cartilage, causing pain and loss of functionality. Currently, there are a variety of new drugs and therapeutic protocols, raising doubts at the time of treatment. Therefore, the objective of this work is to provide a review of the literature with recent information, to provide an updated recommendation for the management of knee osteoarthritis. MATERIALS AND METHODS: A non-systematic review of studies published between January 2000 and August 2020 were performed, using the MeSH terms "knee", "osteoarthritis" and "therapeutics". PubMed, The Cochrane Library, and Trip Database were used as search engines, excluding studies in animals and the pediatric population. ABSTRACT: It is important to highlight that regardless of the treatment modality, it must be stepped and individualized, since each patient will respond differently. Lifestyle changes, self-care, and education are recommended first. Secondly, kinesiotherapy, followed by topical and oral pharmacology (NSAIDs and paracetamol) and as a last option, intra-articular treatment based on corticosteroids. CONCLUSION: Treatment of osteoarthritis of the knee should be comprehensive and focused on both pharmacological and non-pharmacological management. Currently, there is no single safe, highly useful, and cost-effective drug for chronic treatment

Humans , Male , Female , Osteoarthritis, Knee/therapy , Conservative Treatment/methods , Self Care , Osteoarthritis, Knee/drug therapy
Medwave ; 19(4): e7623, 2019.
Article in English, Spanish | LILACS | ID: biblio-997900


INTRODUCCIÓN La artrosis de rodilla es una enfermedad crónica altamente prevalente, asociada a diversos factores de riesgo y con múltiples opciones para su tratamiento. Dentro de los factores de riesgo más importantes se encuentra el sobrepeso, que además constituye un factor agravante de los síntomas. Se ha planteado que la baja de peso es beneficiosa en el manejo de los síntomas y detención de la progresión, pudiendo lograrse a través de distintos métodos: ejercicio, dietas, fármacos, cirugía, o bien una combinación de ellos. Aparentemente, la dieta constituye una opción razonable dado su disponibilidad, baja complejidad técnica y mayor disposición a una buena adherencia, especialmente en población susceptible a desarrollar artrosis de rodilla, pero no existe claridad sobre el beneficio de la dieta como medio exclusivo para lograr una mejoría en los síntomas. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas y analizamos los datos de los estudios primarios. Con esta información, generamos un resumen estructurado denominado FRISBEE (Friendly Summaries of Body of Evidence using Epistemonikos), siguiendo un formato preestablecido, que incluye mensajes clave, un resumen del conjunto de evidencia (presentado como matriz de evidencia en Epistemonikos), metanálisis del total de los estudios cuando sea posible, una tabla de resumen de resultados con el método GRADE y una sección de otras consideraciones para la toma de decisión. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas, que en conjunto incluyeron seis estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que la dieta podría mejorar la funcionalidad y la calidad de vida, con probablemente mínimos o nulos efectos adversos. Sin embargo, no está claro si disminuye el dolor porque la certeza de la evidencia es muy baja.

INTRODUCTION Knee osteoarthritis is a highly prevalent chronic disease, associated with various risk factors and with multiple treatment options. Overweight is among the main risk factors and also constitutes an aggravating factor of the symptoms. It has been suggested that weight loss would be able to improve symptoms and to stop the progression. It can be achieved by several methods: exercise, diet, drugs, surgery, or a combination of them. Apparently, diet is a reasonable option given its availability, low technical complexity and greater acceptability, especially in the population susceptible to developing knee osteoarthritis, but it is not clear whether the benefit of diet as the only intervention leads to symptomatic improvement. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including six primary studies overall, all corresponding to randomized trials. We concluded diet may improve functionality and quality of life, with probably minimal or no adverse effects. However, we are uncertain whether diet reduces pain as the certainty of the evidence has been assessed as very low.

Humans , Pain/drug therapy , Quality of Life , Osteoarthritis, Knee/drug therapy , Pain/etiology , Weight Loss , Databases, Factual , Non-Randomized Controlled Trials as Topic
Adv Rheumatol ; 59: 39, 2019. tab, graf
Article in English | LILACS | ID: biblio-1088635


Abstract Background: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. Main body: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. Conclusions: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.

Humans , Osteoarthritis, Knee/drug therapy , Prolotherapy/instrumentation , Glucose Solution, Hypertonic/therapeutic use , Health Evaluation , Treatment Outcome
Cad. Saúde Pública (Online) ; 35(10): e00098618, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1039384


Resumo: A osteoartrite de joelho afeta cerca de 3,8% da população mundial e se manifesta por dor, edema, rigidez e redução da função articular, impactando na qualidade de vida do paciente. O tratamento consiste na modalidade farmacológica, não farmacológica e cirúrgica. A viscossuplementação (ácido hialurônico intra-articular) se propõe a oferecer alívio dos sintomas e a possibilidade de adiamento da cirurgia. Este estudo estimou o impacto orçamentário entre a associação desse medicamento e o tratamento não cirúrgico (tratamento padrão), sob a perspectiva do Sistema Único de Saúde. Com base no pressuposto de que 5% dos portadores da doença seguem para tratamento e nos custos diretos das modalidades: farmacológica e não farmacológica foram calculados os cenários de referência e alternativos que compararam as diferentes opções de tratamento para um horizonte temporal de três anos. A análise principal estimou um impacto orçamentário incremental de aproximadamente R$ 126 milhões (1 ampola anual) e R$ 252 milhões (2 ampolas anuais). Já a diacereína, um condroprotetor oral, avaliada como uma opção alternativa, mostrou um impacto de R$ 334 milhões no orçamento em relação ao tratamento padrão, o que proporciona um aumento de 24% no custo em relação ao uso de 2 ampolas anuais de ácido hialurônico, tornando-a economicamente menos vantajosa. A viscossuplementação pode proporcionar maior qualidade de vida ao paciente, redução de custos para o sistema e otimização do fluxo de atendimento nas unidades de saúde. As estimativas apresentadas neste estudo podem auxiliar o gestor quanto à melhor utilização dos recursos financeiros e consequente tomada de decisão quanto à incorporação da tecnologia.

Abstract: Knee osteoarthritis affects 3.8% of the world population and manifests as pain, edema, stiffness, and reduced joint function, impacting the patient's quality of life. Treatment consists of the pharmacological, non-pharmacological, and surgical modalities. Viscosupplementation (intraarticular hyaluronate) has been proposed to relieve symptoms and potentially postpone surgery. This study estimated the budget impact of the association of this drug and non-surgical treatment (standard treatment) from the perspective of the Brazilian Unified National Health System. Based on the assumption that 5% of patients proceed to treatment and on the direct costs of the pharmacological and non-pharmacological modalities, the authors calculated the reference and alternative scenarios that compared the different treatment options in a three-year timeline. The principal analysis estimated an incremental budget impact of approximately BRL 126 million (U$ 32 million) for one vial of hyaluronate a year and BRL 252 million (USD 64 million) for two vials a year. Diacerein, an oral chondroprotector, assessed as an alternative, showed a budget impact of BRL 334 million (USD 86 million) in relation to standard treatment, representing a 24% cost increase compared to two vials a year of hyaluronate, making it less economically advantageous. Viscosupplementation can provide better quality of life for patients, reduce costs for the health system, and optimize the flow of care in health services. The estimates presented in this study can assist administrators in the best use of resources and thus in decision-making on the technology's incorporation.

Resumen: La osteoartritis de rodilla afecta a cerca de un 3,8% de la población mundial y se manifiesta por dolor, edema, rigidez y reducción de la función articular, impactando en la calidad de vida del paciente. El tratamiento consiste en la modalidad farmacológica, no farmacológica y quirúrgica. La viscosuplementación (ácido hialurónico intraarticular) se propone ofrecer un alivio de los síntomas y la posibilidad de un aplazamiento de la cirugía. Este estudio estimó el impacto presupuestario entre la asociación de este medicamento y el tratamiento no quirúrgico (tratamiento estándar), desde la perspectiva del Sistema Único de Salud. Basándonos en el supuesto de que un 5% de los portadores de la enfermedad siguen el tratamiento y en los costos directos de las modalidades tanto farmacológica, como no farmacológica, se calcularon los escenarios de referencia y alternativos que compararon las diferentes opciones de tratamiento para un horizonte temporal de tres años. El análisis principal estimó un impacto presupuestario incremental de aproximadamente BRL 126 millones (1 ampolla anual) y BRL 252 millones (2 ampollas anuales). En el caso de la diacereína, un condroprotector oral, evaluado como una opción alternativa, mostró un impacto de BRL 334 millones en el presupuesto, respecto al tratamiento estándar, lo que proporciona un aumento de un 24% en el costo, en relación con el uso de 2 ampollas anuales de ácido hialurónico, haciéndola económicamente menos ventajosa. La viscosuplementación puede proporcionar mayor calidad de vida al paciente, reducción de costes para el sistema y la optimización del flujo de atención en las unidades de salud. Las estimaciones presentadas en este estudio pueden ayudar al gestor en lo referente a una mejor utilización de los recursos financieros y, consecuentemente, en la toma de decisiones respecto a la incorporación de tecnología.

Humans , Osteoarthritis, Knee/drug therapy , Viscosupplements/therapeutic use , Viscosupplementation/economics , Hyaluronic Acid/therapeutic use , Brazil/epidemiology , Budgets , Prevalence , Osteoarthritis, Knee/epidemiology , National Health Programs
Braz. J. Pharm. Sci. (Online) ; 54(4): e17773, 2018. tab, graf
Article in English | LILACS | ID: biblio-1001572


The present study aimed to evaluate the effect of the adjuvant use of resveratrol with meloxicam on the clinical scores of knee OA patients. This was a double-blind placebo-controlled randomised trial involving 100 patients with knee osteoarthritis performed at the Shar Teaching Hospital, Sulaimani General Hospital and Specialised Rheumatology Center, Sulaimani City from December 2016 to September 2017. The efficacy of the treatment was evaluated by measuring the changes from baseline in the KOOS score, WOMAC index, and VAS-100 score after 90 days of treatment. Resveratrol significantly improves the knee OA pain and associated symptoms compared with placebo, and both clinical scores were found to be eligible for following treatment outcomes. In conclusion, resveratrol, when used in combination with meloxicam, improves pain and symptom scores in patients with mild-to-moderate knee OA compared with placebo. The intervention with a dietary supplement may significantly impact the pain and overall quality of life in patients with knee OA.

Humans , Male , Female , Middle Aged , Aged , Double-Blind Method , Treatment Outcome , Osteoarthritis, Knee/drug therapy , /analysis , /analysis
Acta ortop. mex ; 31(6): 283-286, nov.-dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-949781


Resumen: Antecedentes: La osteoartritis de rodilla es una enfermedad articular caracterizada por degeneración, pérdida del cartílago y alteración del hueso subcondral asociadas a cambios en los tejidos blandos. En una muestra de 2,500 individuos se encontró una prevalencia de artrosis de 2.3% (IC 95% 1.7 a 2.9) en adultos. En nuestro hospital representa la segunda causa de consulta. Material y métodos: Se tomaron dos grupos de pacientes: el primero, de 70 pacientes a los que se les aplicó hilano G-F 20 en tres infiltraciones; al otro grupo, de 40 pacientes, se le aplicó colágeno-PVP en cuatro aplicaciones. Se les realizó un interrogatorio basado en el cuestionario de WOMAC, con el cual pudimos valorar dolor, rigidez y capacidad funcional antes y después de la aplicación de los medicamentos. Resultados: Nuestro estudio presentó que en ambos grupos hubo mejora de la calidad de vida al disminuir los síntomas tales como dolor, rigidez y limitación funcional; el colágeno fue más eficiente para la disminución del dolor y el hialino G-F 20, para la disminución de la rigidez y la limitación funcional. Conclusiones: Ambos tratamientos mostraron seguridad y eficacia. Su uso en nuestro instituto para los pacientes fuera de tratamiento quirúrgico puede disminuir de manera importante los internamientos por dolor, con lo que podemos hacer un uso más eficiente de los recursos con que contamos.

Abstract: Background: Knee osteoarthritis is a joint disease characterized by degeneration, loss of cartilage and subchondral bone alteration associated with changes in the soft tissues. In a sample of 2,500 individuals, the prevalence of osteoarthritis was found in 2.3% (IC 95% 1.7 a 2.9) in adults; it represents the second cause of consultation in our hospital. Material and methods: Two groups of patients were studied: the first included 70 patients who received hylan G-F 20 in three infiltrations; the other group, of 40 patients, received collagen-PVP in four applications. A subjective questionnaire based on the WOMAC evaluation was applied, with which we could assess pain, stiffness and functional capacity before and after the application. Results: Both hylan G-F 20 and collagen-PVP improved the quality of life of our patients by reducing symptoms such as pain, stiffness and functional limitation, collagen being more efficient for reducing pain and hylan G-F 20 for reducing stiffness and functional limitation. Conclusions: Both treatments were safe and effective; they can be used in our institute as a conservative treatment to decrease hospitalizations for pain management.

Humans , Adult , Collagen/therapeutic use , Povidone/therapeutic use , Osteoarthritis, Knee/drug therapy , Hyaluronic Acid/analogs & derivatives , Quality of Life , Treatment Outcome , Hyaluronic Acid/therapeutic use , Injections, Intra-Articular
Brasília; CONITEC; ago. 2017.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-908690


CONTEXTO: A SCTIE propôs a ampliação de uso do naproxeno para o controle da dor associada à osteoartrite do joelho e do quadril. TECNOLOGIA: Naproxeno 250 a 500mg. INDICAÇÃO: Controle da dor associada à osteoartrite de joelho e quadril. PERGUNTA: O uso do naproxeno no controle da dor associada à osteoartrite do joelho e do quadril é eficaz e seguro quando comparado aos outros anti-inflamatórios não esteroides (AINE) não seletivos? EVIDÊNCIAS CIENTÍFICAS: Foram selecionadas 3 revisões sistemáticas com metanálise. O naproxeno apresentou eficácia superior ao paracetamol e apresentou menores riscos de infarto do miocárdio e de eventos cardiovasculares totais, juntamente com o ibuprofeno para o último desfecho, que os outros AINES avaliados. DECISÃO: Os membros da CONITEC deliberaram por recomendar a ampliação de uso de naproxeno para osteoartrite de quadril e joelho. Foi assinado o Registro de Deliberação nº 298/2017.(AU)

Humans , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Naproxen/therapeutic use , Osteoarthritis, Hip/drug therapy , Osteoarthritis, Knee/drug therapy , Brazil , Cost-Benefit Analysis , Technology Assessment, Biomedical , Unified Health System
Rev. bras. reumatol ; 57(3): 229-237, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-899416


ABSTRACT Background: Despite the widespread treatments for osteoarthritis (OA), data on treatment patterns, adequacy of pain relief, and quality of life are limited. The prospective multinational Survey of Osteoarthritis Real World Therapies (SORT) was designed to investigate these aspects. Objectives: To analyze the characteristics and the patient reported outcomes of the Portuguese dataset of SORT at the start of observation. Methods: Patients ≥50 years with primary knee OA who were receiving oral or topical analgesics were eligible. Patients were enrolled from seven healthcare centers in Portugal between January and December 2011. Pain and function were evaluated using the Brief Pain Inventory (BPI) and WOMAC. Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). Inadequate pain relief (IPR) was defined as a score >4/10 on item 5 of the BPI. Results: Overall, 197 patients were analyzed. The median age was 67.0 years and 78.2% were female. Mean duration of knee OA was 6.2 years. IPR was reported by 51.3% of patients. Female gender (adjusted odds ratio - OR 2.15 [95%CI 1.1, 4.5]), diabetes (OR 3.1 [95%CI 1.3, 7.7]) and depression (OR 2.24 [95%CI 1.2, 4.3]) were associated with higher risk of IPR. Patients with IPR reported worst outcomes in all dimensions of WOMAC (p < 0.001) and in all eight domains and summary components of SF-12 (p < 0.001). Conclusions: Our findings indicate that improvements are needed in the management of pain in knee OA in order to achieve better outcomes in terms of pain relief, function and quality of life.

RESUMO Antecedentes: Apesar dos tratamentos muito difundidos para a osteoartrite (OA), dados sobre os padrões de tratamento, a adequação do alívio da dor e a qualidade de vida são limitados. O estudo multinacional prospectivo Survey of Osteoarthritis Real World Therapies (SORT) foi projetado para investigar esses aspectos. Objetivos: Analisar as características e os desfechos relatados pelo paciente do conjunto de dados português do Sort no início da observação. Métodos: Consideraram-se elegíveis os pacientes com 50 anos ou mais com OA de joelho primária que recebiam analgésicos orais ou tópicos. Os pacientes foram recrutados de sete centros de saúde de Portugal entre janeiro e dezembro de 2011. A dor e a função foram avaliadas pelo Brief Pain Inventory (BPI) e pelo WOMAC. A qualidade de vida foi avaliada com o 12-item Short Form Health Survey (SF-12). O alívio inadequado da dor (AID) foi definido como uma pontuação > 4/10 no item 5 do BPI. Resultados: Foram analisados 197 pacientes. A idade média foi de 67 anos e 78,2% eram do sexo feminino. A duração média da OA de joelho foi de 6,2 anos. O AID foi relatado por 51,3% dos pacientes. O sexo feminino (odds ratio ajustado - OR 2,15 [IC 95% 1,1-4,5]), o diabetes (OR = 3,1 [IC 95% 1,3-7,7]) e a depressão (OR 2,24 [IC 95% 1,2-4,3]) estiveram associados a um maior risco de AID. Os pacientes com AID relataram piores desfechos em todas as dimensões do Womac (p < 0,001) e em todos os oito domínios e nos dois componentes sumários do SF-12 (p < 0,001). Conclusões: Os resultados do presente estudo indicam que é necessário melhorar o manejo da dor na OA de joelho a fim de alcançar melhores desfechos em termos de alívio da dor, função e qualidade de vida.

Humans , Male , Female , Aged , Aged, 80 and over , Osteoarthritis, Knee/drug therapy , Analgesics/therapeutic use , Portugal , Quality of Life , Pain Measurement , Cross-Sectional Studies , Prospective Studies , Treatment Outcome , Osteoarthritis, Knee/diagnosis , Patient Reported Outcome Measures , Middle Aged
Braz. j. med. biol. res ; 50(9): e6314, 2017. graf
Article in English | LILACS | ID: biblio-888989


Strontium ranelate (SrRan) is a drug usually prescribed to treat osteoporosis, with proven effects of decreasing the risk of fractures and an indication of reducing the progression of osteoarthritis (OA). This study aimed to investigate the effects of SrRan as either a prophylactic or a treatment drug, using an OA rat model to assess pain behavior. A monoiodoacetate (MIA)-induced knee joint OA model in Wistar rats was used. Thirty Wistar rats (both sexes, 60 days old) were distributed in five groups of 6 rats each: the control group, that received no intervention; a prophylactic group, that received oral administration of 25 mg·kg-1·day-1 of SrRan for 28 days before induction of OA; a group treated with 25 mg·kg-1·day-1 of SrRan for 28 days after OA induction; a group treated with 50 mg·kg-1·day-1 during 28 days after OA induction; and a group that received oral saline for 28 days after induction. The assessment of pain behavior was performed considering articular incapacitation (weight-bearing test), mechanical hyperalgesia (Randall Selitto test) and motor activity (rotarod test), on days 0, 7, 14, 21, and 28. This experiment did not yield a significant difference when comparing the group that received SrRan prophylactically with the groups treated with 25 or 50 mg·kg-1·day-1 and the group that received oral saline. Thus, SrRan did not provide analgesia in either treated rats or as a prophylactic drug with the tested doses. Higher doses should be tested further to achieve possible significant results.

Animals , Male , Rats , Bone Density Conservation Agents/therapeutic use , Hyperalgesia/drug therapy , Osteoarthritis, Knee/drug therapy , Thiophenes/therapeutic use , Disease Models, Animal , Rats, Wistar
Braz. j. med. biol. res ; 50(4): e5714, 2017. tab, graf
Article in English | LILACS | ID: biblio-839285


Inflammation of cartilage is a primary symptom for knee-joint osteoarthritis. Matrix metalloproteinases (MMPs) are known to play an important role in the articular cartilage destruction related to osteoarthritis. Naringenin is a plant-derived flavonoid known for its anti-inflammatory properties. We studied the effect of naringenin on the transcriptional expression, secretion and enzymatic activity of MMP-3 in vivo in the murine monosodium iodoacetate (MIA) osteoarthritis model. The assessment of pain behavior was also performed in the MIA rats. The destruction of knee-joint tissues was analyzed microscopically. Moreover, the effect of naringenin was also studied in vitro in IL-1β activated articular chondrocytes. The transcriptional expression of MMP-3, MMP-1, MMP-13, thrombospondin motifs (ADAMTS-4) and ADAMTS-5 was also studied in primary cultured chondrocytes of rats. Naringenin caused significant reduction in pain behavior and showed marked improvement in the tissue morphology of MIA rats. Moreover, a significant inhibition of MMP-3 expression in MIA rats was observed upon treatment with naringenin. In the in vitro tests, naringenin caused a significant reduction in the transcriptional expression, secretion and enzymatic activity of the studied degradative enzymes. The NF-κB pathway was also found to be inhibited upon treatment with naringenin in vitro. Overall, the study suggests that naringenin alleviated pain and regulated the production of matrix-metalloproteinases via regulation of NF-κB pathway. Thus, naringenin could be a potent therapeutic option for the treatment of osteoarthritis.

Animals , Male , Anti-Inflammatory Agents/pharmacology , Arthralgia/enzymology , Chondrocytes/enzymology , Flavanones/pharmacology , Knee Joint/enzymology , Matrix Metalloproteinase 3/biosynthesis , Osteoarthritis, Knee/enzymology , Arthralgia/drug therapy , Blotting, Western , Cell Proliferation/drug effects , Cells, Cultured , Chondrocytes/drug effects , Disease Models, Animal , Gene Expression , Interleukin-1beta/analysis , Interleukin-1beta/drug effects , Interleukin-1beta/metabolism , Knee Joint/pathology , Matrix Metalloproteinase 3/analysis , NF-kappa B/analysis , NF-kappa B/drug effects , NF-KappaB Inhibitor alpha/analysis , NF-KappaB Inhibitor alpha/drug effects , Osteoarthritis, Knee/drug therapy , Osteoarthritis, Knee/pathology , Random Allocation , Rats, Wistar , Reproducibility of Results , Reverse Transcriptase Polymerase Chain Reaction , Time Factors , Treatment Outcome
Rio de Janeiro; s.n; 2016. 109 p.
Thesis in Portuguese | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1222868


A infiltração visa restaurar as propriedades reológicas do líquido sinovial, diminuir o processo inflamatório e mudar o curso natural da osteoartrite. Estudos comprovaram que o uso isolado de ácido hialurônico apresenta uma ação analgésica mais duradoura quando comparado ao corticoide. O uso associado desses medicamentos diminuiriam a chance de sinovite reacional, que pode acontecer na viscosuplementação isolada. O estudo objetiva avaliar a ação isolada e conjunta da infiltração intra-articular do ácido hialurônico (Orthovisc®) e da dexamethasona no tratamento da osteoartrite do joelho. A citotoxicidade in vitro de diferentes doses de ácido hialurônico e da dexamethasona foi avaliada. Nossos resultados não mostraram alterações na viabilidade celular representativa dos condrócitos que foram tratados. O Ensaio clínico avaliou 43 pacientes em tratamento para osteoartrite no ambulatório do Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad. Os pacientes foram selecionados através de uma análise clínico-radiológica, randomizados de forma homogênea em 3 grupos. Os pacientes receberam injeções intra-articulares no joelho. O grupo A foi infiltrado com 6 ml de ácido hialurônico (15 pacientes), o grupo B foi infiltrado com 1ml Dexamethasona mais 6 ml de ácido hialurônico (16pacientes), e no grupo C foi infiltrado 1ml de Dexamethasona (12 pacientes). Todos os pacientes foram avaliados antes da infiltração e após, na sexta semana, no terceiro e sexto mês, foram também aplicados o questionário de Womac para análise subjetiva da força, dor e rigidez, e analisados de forma objetiva, a força e a propriocepção do membro inferior, através de um dinamômetro isocinético. Houve diferença entre os grupos nas análises objetivas de força e propriocepção nos primeiros 3 meses de tratamento, entretanto no segundo trimestre não foi observado melhora representativa na qualidade de vida, força ou propriocepção dos pacientes

The infiltration aims to restore the rheological properties of synovial fluid, decreasing the inflammatory process and changing the natural course of osteoarthritis. Studies show that the use of hyaluronic acid by itself has a lasting analgesic effect compared to corticosteroids. The combined use of these drugs decrease the chance of reactivity synovitis, which can be seen in isolated viscosupplementation. The study aims to evaluate the action of intra-articular infiltration of hyaluronic acid (Orthovisc®) and dexamethasone, together and isolated to treat osteoarthritis of the knee. The cytotoxicity in vitro of various doses of hyaluronic acid and dexamethasone was evaluated. Our results showed no representative changes in chondrocytes viability that were treated. The clinical trial evaluated 43 patients undergoing treatment for osteoarthritis in the clinic of the National Institute of Traumatology and Orthopedics Jamil Haddad. Patients were selected through a clinical and radiological analysis, randomized evenly into 3 groups. Patients received intra-articular injections into the knee. Group A was infiltrated with 6 ml of hyaluronic acid (15 patients), group B was infiltrated with 1ml Dexamethasona 6 more ml of hyaluronic acid (16 patients), and group C was infiltrated 1ml Dexamethasona (12 patients). All patients were evaluated before and after infiltration, in the sixth week in the third and sixth month, were applied the Womac questionnaire for subjective analysis of strength, stiffness and pain, and also analyzed objectively the strength and proprioception of the lower member, using an isokinetic dynamometer. There were differences between the groups in the objective analysis of strength and proprioception in the first 3 months of treatment, however in the second quarter there was not representative improvement observed in quality of life, strength and proprioception of patients

Humans , Dexamethasone , Osteoarthritis, Knee/drug therapy , Hyaluronic Acid
Article in English | WPRIM | ID: wpr-11687


We aimed to compare the clinical outcomes of knee osteoarthritis patients according to drug adherence; and to find out the factors the affecting those outcomes. We analyzed the drug adherence and clinical outcomes in 1,334 primary knee osteoarthritis patients who took non-steroidal anti-inflammatory drugs (NSAIDs) for 3 weeks. Clinical outcomes of Pain Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS) and EQ-5D were compared at baseline and 3 weeks' follow-up between the two groups of adherent group and non-adherent group (1,167 vs. 167 patients). Logistic regression analysis was performed to examine the factors affecting the adherence, and the reasons for the non-adherence were asked. The follow-up clinical outcomes of NRS and KOOS symptom, pain and activity of daily life were significantly higher in the adherence group (P = 0.003, P = 0.048, P = 0.005, and P = 0.003, respectively). The adherence was better in the elderly and in the male group (P = 0.042 and P = 0.034, respectively) and the top reason for no strict adherence was "symptom improved" (21.5%) followed by side effects. In this study, the patients with better adherence to NSAIDs showed better outcomes compared to those with poor adherence. This study can contribute to the patient education for the pharmacological treatment in knee OA patients.

Age Factors , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Female , Humans , Knee Joint/pathology , Logistic Models , Male , Medication Adherence , Osteoarthritis, Knee/drug therapy , Pain Measurement , Prospective Studies , Sex Factors
Rev. bras. anestesiol ; 65(5): 333-337, Sept.-Oct. 2015. tab
Article in English | LILACS | ID: lil-763130


ABSTRACTBACKGROUND AND OBJECTIVES:Tenoxicam is widely used in osteoarthritis treatment and we aimedto compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthri-tis treatment.METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing andcomparing the findings of 60 patients who were clinically and radiologically diagnosed with kneedegenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in thestudy were divided into two groups. The first group (tenoxicam IA, n = 30) included patientfindings of those subjected to intra-articular injection of 20 mg tenoxicam to the knee oncea week for three weeks and the second group (oral tenoxicam, n = 30) included patients whowere administered 20 mg oral tenoxicam once a day for three weeks. All patients were clini-cally evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatmentaccording to specified criteria.RESULTS AND CONCLUSIONS: Twenty two of 60 patients included in the study were male and 38were female. In both groups significant improvements were detected in all of the observedparameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physicalactivity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week,1st month and 3rd month with respect to pre-treatment values. Besides, a better complianceto treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed.Intra-articular tenoxicam administration could be thought as an alternative treatment methodin patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemicgastrointestinal system side effects and those who have difficulties in adapting to treatment.

RESUMOJUSTIFICATIVA E OBJETIVOS: Tenoxicam é amplamente usado no tratamento da osteoartrite (OA)e o nosso objetivo foi comparar a eficácia de tenoxicam administrado por via oral (VO) e intra-articular (IA) no tratamento da OA.MÉTODOS: Este estudo foi conduzido entre 2011 e 2012 por meio de análise retrospectiva ecomparação dos resultados de 60 pacientes que foram clínica e radiologicamente diagnosticadoscom OA degenerativa de joelhos na Policlínica de Tratamento da Dor do Hospital Estadual deBünyan. Os 60 pacientes incluídos no estudo foram alocados em dois grupos. O primeiro grupo(tenoxicam IA, n = 30) incluiu resultados de pacientes submetidos à injeção nos joelhos porvia IA de 20 mg de tenoxicam uma vez por semana durante três semanas e o segundo grupo(tenoxicam VO, n = 30) incluiu pacientes que receberam 20 mg de tenoxicam por VO uma vezpor dia durante três semanas. Todos os pacientes foram avaliados clinicamente na fase basalpré-tratamento e em uma semana, um mês e três meses pós-tratamento, de acordo com oscritérios especificados.RESULTADOS E CONCLUSÕES: Dos 60 pacientes, 22 eram do sexo masculino e 38 do sexo feminino.Em ambos os grupos, melhorias significativas foram detectadas em todos os parâmetros da escalavisual analógica, do índice Western Ontario and MacMaster (Womac --- dor, atividade física erigidez dos joelhos) e do índice de Lequesne nas avaliações feitas em uma semana, um mês etrês meses e comparadas aos valores basais. Além disso, uma melhor adesão ao tratamento etolerabilidade ao sistema gastrointestinal no grupo tenoxicam IA também foram observadas. Aadministração de tenoxicam IA pode ser considerada como um método opcional de tratamentoem pacientes com OA de joelhos que não podem usar tenoxicam por VO, especialmente porcausa dos efeitos colaterais sobre o sistema gastrintestinal, e naqueles com dificuldades de adaptação ao tratamento.

Humans , Male , Female , Aged , Piroxicam/analogs & derivatives , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Osteoarthritis, Knee/drug therapy , Piroxicam/administration & dosage , Piroxicam/adverse effects , Administration, Oral , Retrospective Studies , Injections, Intra-Articular , Middle Aged
Säo Paulo med. j ; 133(1): 4-12, Jan-Fev/2015. tab, graf
Article in English | LILACS | ID: lil-733011


CONTEXT AND OBJECTIVE: The development of a slow and progressive mechanical model for osteoarthritis is important for correlation with clinical practice, and for evaluating the effects of disease-modifying medications. A mechanical osteoarthritis model was developed to evaluate the effects of intra-articular hyaluronic acid (HA) injection and oral diacerein administration. DESIGN AND SETTING: Experimental study at the Department of Orthopedics and Traumatology, Universidade de São Paulo. METHOD: Total medial meniscectomy was performed on seven groups of ten Wistar rats each, comprising four control groups (C) and three study groups (S). C.I: operated, non-medicated; C.II: operated, injections of HA vehicle; C.III: non-operated, non-medicated; C.IV: operated, non-medicated, sacrificed three months post-meniscectomy; S.I: operated, receiving intra-articular HA injections; S.II: operated, oral diacerein from the third to the seventh postoperative month; S.III: operated, received both medications. All the animals (except C.IV) were sacrificed seven months post-meniscectomy. All femurs and tibias were assessed histologically. RESULTS: The most severe degenerative histological changes were in the tibias of the operated knees. On the contralateral side, all groups had mild changes on the tibial surface. The femoral surface had ...

CONTEXTO E OBJETIVO: Desenvolver um modelo osteoartrítico mecânico lento e progressivo é importante para correlação com a prática clínica e para avaliar os efeitos de medicamentos modificadores da doença. Um modelo mecânico de osteartrite foi desenvolvido para avaliar os efeitos de injeção intra-articular de hialuronato de sódio (AH) e de administração de diacereína oral. DESENHO E LOCAL: Estudo experimental no Departamento de Ortopedia e Traumatologia, Universidade de São Paulo. MÉTODO: Meniscectomia medial total foi feita em sete grupos de dez ratos Wistar, sendo quatro grupos controle (C) e três grupos estudo (E). C.I: operado, não medicado; C.II: operado, recebendo injeções do veículo do AH; C.III: não operado, não medicado; C.IV: operado, não medicado, sacrificado três meses pósmeniscectomia; EI: operado, recebendo injeções de AH intra-articular; E.II: operado, recebendo diacereína oral do terceiro ao sétimo mês pós-operatório; E.III: operado, recebeu ambas medicações. Todos os animais (exceto C.IV) foram sacrificados sete meses pós-meniscectomia. Todos os fêmures e tíbias foram analisados histologicamente. RESULTADOS: As alterações histológicas degenerativas ...

Animals , Male , Anthraquinones/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Arthritis, Experimental/drug therapy , Hyaluronic Acid/administration & dosage , Menisci, Tibial/surgery , Osteoarthritis, Knee/drug therapy , Viscosupplements/administration & dosage , Administration, Oral , Arthritis, Experimental/etiology , Arthritis, Experimental/pathology , Disease Models, Animal , Disease Progression , Drug Therapy, Combination , Injections, Intra-Articular , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/pathology , Random Allocation , Rats, Wistar , Severity of Illness Index
PAFMJ-Pakistan Armed Forces Medical Journal. 2015; 65 (1): 77-80
in English | IMEMR | ID: emr-168287


To identify the efficacy and side effects of Diacerein in patients with mild to moderate knee mteoarthritis. Quasi experimental study. Outpatient Department of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from June 2012 to June 2013. Ninety cases fulfilling American College of Rheumatology criteria for diagnosis of Knee Osteoarthritis and falling in Grades I-III of Kellgren-Lawrence Radiological Classification for Knee Osteoarthritis were included. Pre-treatment associated symptoms, complete blood count, renal and liver function tests were documented. After a baseline pain assessment on a 10-Point Visual Analogue Scale, 50 mg of Diacerein was given orally for 4 months followed by pain assessment and inquiry about adverse effects at 6[th] week, 3[rd] and 6[th] months. Post-treatment labs were repeated. Reduction in pain was analyzed by paired-sample t-test using SPSS version 17. Chi-Square test was used to assess the frequency of adverse effects. A p-value < 0.05 was considered sigruficant. Mean age was 61.5 +/- 7.8 years. Majority 77 [85.6%] were females. Mean Visual Analogue Scale at start was 6.1 +/- 0.87. Sigruficant pain reduction measured on Visual Analogue Scale was observed at six weeks [4.6 +/- 1.2] [p < 0.001], three months [2.37 +/- 0.91] [p < 0.001] and six months [2.2 +/- 0.85] [p < 0.001]. Very few patients developed diarrhea 3.3% and nausea 4.4%. Diacerein is effective drug with minimal side effects for treatment of mild to moderate painful Knee Osteoarthritis

Humans , Male , Female , Osteoarthritis, Knee/drug therapy