Efficacy and Safety of Etodolac-Paracetamol Fixed Dose Combination in Patients With Knee Osteoarthritis Flare-up: A Randomized, Double-blind Comparative Evaluation

Pareek, Anil; Chandurkar, Nitin; Ambade, Ratnakar; Chandanwale, Ajay; Bartakke, Girish

doi:10.1097/ajp.0b013e3181e15bba

Cited by 14 publications

(8 citation statements)

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“… 29 45 73 75 In studies using various forms of Investigator/Physician Global Assessment, the majority adopted a minimum threshold for a flare of ‘fair, poor or very poor’. 29 30 45 73 The minimum threshold on the Lequesne index (0–10) was either 5 53 or 7. 46 51 60 …”

Section: Resultsmentioning

confidence: 99%

Defining acute flares in knee osteoarthritis: a systematic review

2018

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ObjectiveTo identify and critically synthesise definitions of acute flares in knee osteoarthritis (OA) reported in the medical literature.DesignSystematic review and narrative synthesis. We searched Medline, EMBASE, Web of science and six other electronic databases (inception to July 2017) for original articles and conference abstracts reporting a definition of acute flare (or synonym) in humans with knee OA. There were no restrictions by language or study design (apart from iatrogenic-induced flare-ups, eg, injection-induced). Data extraction comprised: definition, pain scale used, flare duration or withdrawal period, associated symptoms, definition rationale, terminology (eg, exacerbation or flare), baseline OA severity, age, gender, sample size and study design.ResultsSixty-nine articles were included (46 flare design trials, 17 observational studies, 6 other designs; sample sizes: 15–6085). Domains used to define flares included: worsening of signs and symptoms (61 studies, 27 different measurement tools), specifically increased pain intensity; minimum pain threshold at baseline (44 studies); minimum duration (7 studies, range 8–48 hours); speed of onset (2 studies, defined as ‘sudden’ or ‘quick’); requirement for increased medication (2 studies). No definitions included activity interference.ConclusionsThe concept of OA flare appears in the medical literature but most often in the context of flare design trials (pain increases observed after stopping usual treatment). Key domains, used to define acute events in other chronic conditions, appear relevant to OA flare and could provide the basis for consensus on a single, agreed definition of ‘naturally occurring’ OA flares for research and clinical application.PROSPERO registration numberCRD42014010169.

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Section: Resultsmentioning

confidence: 99%

Defining acute flares in knee osteoarthritis: a systematic review

2018

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“…In addition to examining participant definitions of pain flare, the degree of concordance between the participant and investigator definitions of pain flare was assessed. The investigator definition, "inadequate pain relief for an episode of intense pain that is usually brought on by too much activity," was derived from the following sources (19,20) as well as the research team's experience. After presenting the definition, participants were asked to rate how well the definition captured their experience of a pain flare on a scale where 0 5 not at all and 4 5 very much.…”

Section: Significance and Innovationsmentioning

confidence: 99%

“…Few studies discuss pain flares in OA except in the context of research design in which potential participants of clinical trials must have a predefined increase in pain to indicate a flare, which may not have clinical relevance for patients (19)(20)(21). Although not well characterized, flares have been described as inflammatory in nature (22) and may be experienced during or after a period of being physically active (23).…”

Section: Introductionmentioning

confidence: 99%

Characterizing Pain Flares From the Perspective of Individuals With Symptomatic Knee Osteoarthritis

Murphy

Lyden

Kratz

et al. 2015

Arthritis Care & Research

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Objective Although pain in knee osteoarthritis (OA) commonly affects activity engagement, the daily pain experience has not been fully-characterized. Specifically, the nature and impact of pain flares is not well-understood. This study characterized pain flares, defined by participants with knee OA; pain flare occurrence and experience were measured over 7 days. Methods This was a multiple methods study; qualitative methods were dominant. Data were collected during the baseline portion of a randomized controlled trial. Participants met criteria for knee OA and had moderate to severe pain. They completed questionnaires and a 7-day home monitoring period that captured momentary symptom reports simultaneously with physical activity via accelerometry (N = 45). Participants also provided individual definitions of pain flare which were used throughout the home monitoring period to indicate whether a pain flare occurred. Results Pain flares were described most often by quality (often sharp), followed by timing (seconds-minutes), and by antecedents and consequences. When asked if their definition of a flare agreed with a supplied definition, 49% of the sample reported only “somewhat”, “a little” or “not at all”. Using individual definitions, 78% experienced at least one daily pain flare over the home monitoring period; 24% had a flare on over 50% of the monitored days. Conclusions Pain flares were common, fleeting, and often experienced in the context of activity engagement. Participants’ views on what constitutes a pain flare differ from commonly accepted definitions. Pain flares are an understudied aspect of the knee OA pain experience and require further characterization.

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“…These modern therapies are successfully employed in clinical practice for PAS treatment. However, the treatment effects are not always long-lasting and most of which disappear in 4 weeks after treatment approximately [ 7 , 8 ]. Moreover, these treatment options may be associated with severe adverse events, such as infectious arthritis and cartilage damage, all of which may put the patient into certain risks of disease deterioration [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Sharp-Hook Acupuncture (Feng Gou Zhen) for Patients with Periarthritis of Shoulder: A Randomized Controlled Trial

Wang

Cao

et al. 2015

Evidence-Based Complementary and Alternative Medicine

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The Feng Gou Zhen (sharp-hook acupuncture) as a traditional form of ancient acupuncture is said to be particularly effective for managing periarthritis of shoulder. We conducted this randomized controlled trial to evaluate the effectiveness of Feng Gou Zhen as an add-on compared to conventional analgesics for patients with PAS. 132 patients were randomly assigned in a 1 : 1 ratio to either a acupuncture group receiving sharp-hook acupuncture plus acupoint injection with conventional analgesics or a control group. Patients from both groups were evaluated at week 0 (baseline), week 1, and week 4. The primary outcome measure was the change from baseline shoulder pain, measured by Visual Analogue Scale at 7 days after treatment. Secondary outcome measures include the (i) function of shoulder joint and (ii) McGill pain questionnaire. The results showed that patients in acupuncture group had better pain relief and function recovery compared with control group (P < 0.05) at 1 week after treatment. Moreover, there were statistical differences between two groups in VAS and shoulder joint function and McGill pain questionnaire at 4 weeks after treatment (P < 0.05). Therefore, the sharp-hook acupuncture helps to relieve the pain and restore the shoulder function for patients with periarthritis of shoulder.

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Efficacy and Safety of Etodolac-Paracetamol Fixed Dose Combination in Patients With Knee Osteoarthritis Flare-up: A Randomized, Double-blind Comparative Evaluation

Abstract: For the treatment of painful OA flare-ups, the etodolac-paracetamol combination can offer improved clinical outcomes by targeting multiple pain pathways. The results of the current study show that etodolac-paracetamol is more effective in the treatment of OA flare-up than etodolac alone.

Cited by 14 publications

References 14 publications

Defining acute flares in knee osteoarthritis: a systematic review

Defining acute flares in knee osteoarthritis: a systematic review

Characterizing Pain Flares From the Perspective of Individuals With Symptomatic Knee Osteoarthritis

Sharp-Hook Acupuncture (Feng Gou Zhen) for Patients with Periarthritis of Shoulder: A Randomized Controlled Trial

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