2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint

Abstract

Background Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide. Aim Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice. Methods A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts. Results Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm. Conclusion This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.

Efficacy and Safety of Tramadol Hydrochloride Twice-Daily Sustained-Release Bilayer Tablets with an Immediate-Release Component for Chronic Pain Associated with Knee Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled, Treatment-Withdrawal Study

“…These results may suggest that the improvement in pain reported during the open-label period was accompanied by decreased stiffness and greater ability to perform general activities. Exercises and physical activity remain the cornerstone for managing the symptoms of osteoarthritis [ 6 , 7 , 9 ], but pain is a major barrier, resulting in a sedentary lifestyle. Thus, the pain relief provided by tramadol in the open-label period and maintained in the double-blind period allowed the patients to increase their activities and ultimately improve their quality of life.…”

“…Non-steroidal anti-inflammatory drugs (NSAIDs) are widely considered as the first-line pharmacologic therapy for osteoarthritis pain [ 6 – 9 ]. However, they are not suitable for all patients due to the risk of gastrointestinal bleeding, cardiovascular side effects, and renal side effects [ 6 , 7 , 10 , 11 ].…”

“…Tramadol has been incorporated into clinical recommendations, with “weak” or “conditional” recommendations for managing pain associated with knee osteoarthritis [ 6 , 7 ], reflecting limited clinical studies and potential concern regarding its tolerability or dependency. Tramadol is a μ -opioid receptor agonist that also inhibits the reuptake of serotonin and norepinephrine.…”

Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach

“…In 2019, ESCEO published a treatment algorithm for the management of knee osteoarthritis [29] which has been endorsed beyond Europe in other continents [30,31].…”

2021 revised algorithm for the management of knee osteoarthritis—the Chinese viewpoint

“…In these last five years, the ESCEO algorithm has been diffused worldwide and endorsed by many national societies including China, Russia and Southeast Asia [15][16][17][18][19]. Recently, Southeast Asian and European ESCEO experts have produced a new guidance providing evidence-based and easy-to-follow advices on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast countries [20].…”