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

Abstract

Aim 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 from 2014, but in 2019 an update was published. Based on this algorithm, a Working Group (WG), including ESCEO members and Chinese experts, wished to see how the new ESCEO algorithm was perceived by Chinese experts in knee OA and how it was integrated into their clinical practice. Methods A WG was held between members of the international ESCEO task force and a group of Chinese experts. Results Non-pharmacological approach should be combined with pharmacological interventions. In step 1, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are the most important background drugs. Evidence, supported by high-quality research, is available only for crystalline glucosamine sulfate (pCGS) and chondroitin sulfate. Topical NSAIDs could be used as an additional option. In step 2, oral NSAIDs could be useful, but cardiovascular/renal/gastrointestinal profiles of the patients should be considered. Intra-articular hyaluronic acid and corticosteroids are alternative to oral NSAIDs, but the evidence is still limited. If steps 1 and 2 are not sufficient, weak opioids could be used. Overall, the conclusions of the ESCEO algorithm are accepted in China for products available in this country. The WG suggests the importance of economic studies, specifically made in China. Conclusion This work provides evidence-based advice to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in China.

A Combination of Celecoxib and Glucosamine Sulfate Has Anti-Inflammatory and Chondroprotective Effects: Results from an In Vitro Study on Human Osteoarthritic Chondrocytes

“…The use of oral NSAIDs (selective or non-selective) is proposed as second step, and short-term therapy, with selective COX-2 inhibitors (COXIBs) preferred in the case of increased gastro-intestinal risk [7]. Despite this protocol being endorsed by several groups of experts from around the world, the recommendation to use SYSADOAs as first-line background treatment for knee OA is not endorsed by other respected scientific societies [8][9][10][11][12]. Recently, the ESCEO working group reinforced the use of GS and CS as first-line long-term treatment for their activity on gut microbiota.…”

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].…”

A Randomized Controlled Trial of Thai Medicinal Plant-4 Cream versus Diclofenac Gel in the Management of Symptomatic Osteoarthritis of the Knee

“…Besides, topical NSAIDs have a better safety profile than oral NSAIDs due to their lower systemic exposure, with far fewer reports of systemic adverse drug reactions [ 18 , 19 ]. Nowadays, topical NSAIDs are increasingly often preferred over oral NSAIDs for local pain management, especially in the elderly [ 20 – 22 ], and are now considered as first-line pharmacologic therapy for symptomatic treatment of osteoarthritis of the knee [ 6 – 9 ].…”