RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis

Costa, Bruno R. da; Reichenbach, Stephan; Keller, Noah; Nartey, Linda; Wandel, Simon; Jüni, Peter; Trelle, Sven

doi:10.1016/s0140-6736(16)30002-2

Cited by 242 publications

(38 citation statements)

References 35 publications

(51 reference statements)

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“…However current large-scale meta-analyses have found strong evidence that paracetamol confers a clinically unimportant reduction in short-term pain for hip and knee OA [165, 166]. In the near future clinical guidelines will likely be adapted to reflect the lack of efficacy of paracetamol for hip and knee OA.…”

Section: Managementmentioning

confidence: 99%

“…NSAIDs have a well-recognized role in the symptomatic relief of OA and can be administered topically or orally. A recent meta-analysis reported strong evidence that diclofenac and etoricoxib are the most efficacious NSAIDs for pain relief in hip and knee OA, producing a moderate to large effect size [166]. However because of the risk of gastrointestinal and cardiovascular adverse events associated with their use, clinical guidelines recommend the use of NSAIDs for hip OA be restricted to the lowest possible doses and duration [5, 7].…”

Section: Managementmentioning

confidence: 99%

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Hip Osteoarthritis: Etiopathogenesis and Implications for Management

2016

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Highly prevalent among the elderly, hip osteoarthritis (OA) carries a heavy burden of disease. Guidelines for the management of hip OA are often extrapolated from knee OA research, despite clear differences in the etiopathogenesis and response to treatments of OA at these sites. We propose that hip OA requires specific attention separate from other OA phenotypes. Our understanding of the etiopathogenesis of hip OA has seen significant advance over the last 15 years, since Ganz and colleagues proposed femoroacetabular impingement (FAI) as an important etiological factor. This narrative review summarizes the current understanding of the etiopathogenesis of hip OA and identifies areas requiring further research. Therapeutic approaches for hip OA are considered in light of the condition’s etiopathogenesis. The evidence for currently adopted management strategies is considered, especially those approaches that may have disease-modifying potential. We propose that shifting the focus of hip OA research and public health intervention to primary prevention and early detection may greatly improve the current management paradigm.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

2016

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“…Both AGS and BGS guidelines recommend to consider rarely and with extreme caution anti-inflammatory drugs (NSAIDs) and COX-2 selective inhibitors use in older adults with persistent pain, owing to risk of gastrointestinal bleeding[30] - which increases in frequency with age[31] - cardiovascular and kidney dysfunction[32,33]. Thereby all patients taking NSAIDs should be assessed for gastrointestinal and renal toxicity, hypertension, heart failure and potential drug-drug interactions; in general short-term NSAIDs use at low effective dosage is allowed in the old population[4,26].…”

Section: Current Approaches To Pain Management In Older Adults: the Rmentioning

confidence: 99%

Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults

Guerriero

2017

WJCC

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Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients.

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“…[5][6][7][8][9][10][11] However, recent publications have aggressively challenged the use of paracetamol for the treatment of symptomatic OA because of a lack of efficacy and a considerable degree of toxicity, especially at the upper end of the standard analgesic dose. [12][13][14] Similarly, safety profiles of oral NSAIDs remain a concern and caution is recommended before selecting the preparation and dose for a patient. 14 Therefore, recent guidelines recommend maintenance therapy to be conducted with symptomatic slow-acting drugs for OA (SYSADOAs), a class of drugs that is recognised to offer a high degree of safety and tolerability.…”

Section: Introductionmentioning

confidence: 99%

Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT)

et al. 2017

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ObjectivesChondroitin sulfate 800 mg/day (CS) pharmaceutical-grade in the management of symptomatic knee osteoarthritis consistent with the European Medicines Agency guideline.MethodsA prospective, randomised, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day)-controlled trial assessing changes in pain on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI) as coprimary endpoints. Minimal-Clinically Important Improvement (MCII), Patient-Acceptable Symptoms State (PASS) were used as secondary endpoints.Results604 patients (knee osteoarthritis) diagnosed according to American College of Rheumalogy (ACR) criteria, recruited in five European countries and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. In the intention-to-treat (ITT) population, pain reduction in VAS at day 182 in the CS group (−42.6 mm) and in celecoxib group (−39.5 mm) was significantly greater than the placebo group (−33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib), while no difference observed between CS and celecoxib. Similar trend for the LI, as reduction in this metric in the CS group (−4.7) and celecoxib group (−4.6) was significantly greater than the placebo group (−3.7) (p=0.023 for CS and p=0.015 for celecoxib), no difference was observed between CS and celecoxib. Both secondary endpoints (MCII and PASS) at day 182 improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles.ConclusionA 800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA.

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RETRACTED: Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis

Abstract: Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland.

Cited by 242 publications

References 35 publications

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults

Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT)

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