Recommendations of the French Society of Rheumatology on pharmacological treatment of knee osteoarthritis

Sellam, Jérémie; Courties, Alice; Eymard, Florent; Ferrero, S; Latourte, Augustin; Ornetti, Paul; Bannwarth, B; Baumann, Laurence; Bérenbaum, Francis; Chevalier, Xavier; Korng, Hang; Fabre, M; Forestier, Romain; Grange, Laurent; Lellouche, Henri; Maillet, Jérémy; Mainard, Didier; Perrot, Serge; Rannou, François; Rat, Anne‐Christine; Roux, Christian; Senbel, Éric; Richette, Pascal

doi:10.1016/j.jbspin.2020.09.004

Cited by 53 publications

(34 citation statements)

References 65 publications

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“…The amount and purity grade of CS in FS represent a key point in the bioactivity assessment. It can be argued that controversial clinical outcomes are probably due to differences in the CS FS composition [ 2 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The CS is extracted from animal tissues, but low reliable and robust manufacturing might produce a final product with varying structural characteristics, eventually containing contaminants, thus raising not only functional but also safety concerns [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lately scientific discussion has arisen on the beneficial effect of Symptomatic Slow Acting Drugs of OA, (SYSADOA)., among which there are products based on extractive CS and/or glucosamine [ 4 , 5 , 6 ]. Recommendations of the French Society of Rheumatology on treatments of knee osteoarthritis highlighted that there was a significant beneficial effect of CS with respect to placebo [ 7 ]. For this reason, glycosamminoglycan-based treatments, orally administered, were suggested as a beneficial support and even therapeutical treatments in initial stages of OA [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Chondroitin Sulfate in USA Dietary Supplements in Comparison to Pharma Grade Products: Analytical Fingerprint and Potential Anti-Inflammatory Effect on Human Osteoartritic Chondrocytes and Synoviocytes

et al. 2021

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The biological activity of chondroitin sulfate (CS) and glucosamine (GlcN) food supplements (FS), sold in USA against osteoarthritis, might depend on the effective CS and GlcN contents and on the CS structural characteristics. In this paper three USA FS were compared to two pharmaceutical products (Ph). Analyses performed by HPAE-PAD, by HPCE and by SEC-TDA revealed that the CS and GlcN titers were up to −68.8% lower than the contents declared on the labels and that CS of mixed animal origin and variable molecular weights was present together with undesired keratan sulfate. Simulated gastric and intestinal digestions were performed in vitro to evaluate the real CS amount that may reach the gut as biopolymer. Chondrocytes and synoviocytes primary cells derived from human pathological joints were used to assess: cell viability, modulation of the NF-κB, quantification of cartilage oligomeric matrix protein (COMP-2), hyaluronate synthase enzyme (HAS-1), pentraxin (PTX-3) and the secreted IL-6 and IL-8 to assess inflammation. Of the three FS tested only one (US FS1) enhanced chondrocytes viability, while all of them supported synoviocytes growth. Although US FS1 proved to be less effective than Ph as it reduced NF-kB, it could not down-regulate COMP-2; HAS-1 was up-regulated but with a lower efficacy. Inflammatory cytokines were markedly reduced by Ph while a slight decrease was only found for US-FS1.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chondroitin Sulfate in USA Dietary Supplements in Comparison to Pharma Grade Products: Analytical Fingerprint and Potential Anti-Inflammatory Effect on Human Osteoartritic Chondrocytes and Synoviocytes

et al. 2021

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“…Viscosupplementation (VS), by intra-articular (IA) injection of hyaluronic acid (HA), has been a globally used symptomatic treatment for knee and other joint osteoarthritis (OA) for over a quarter-century. 1 VS is recommended in the management of symptomatic knee OA, for appropriate patients, by many scholarly societies of rheumatology and orthopaedics, 2 – 6 geriatrics 7 and sport medicine. 8 These recommendations are based on systematic reviews and meta-analyses that consider VS as an efficient and reliable therapy.…”

Section: Introductionmentioning

confidence: 99%

Viscosupplementation for the treatment of osteoarthritis. The contribution of EUROVISCO group

Conrozier

Raman

Chevalier

et al. 2021

Therapeutic Advances in Musculoskeletal

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Viscosupplementation (VS) is a symptomatic treatment for knee and other joint osteoarthritis (OA). Despite a long history of use, conflicting opinions remain on the best clinical indications and the most appropriate patients to be treated with intra-articular hyaluronic acid (IA-HA), the optimal dosing regimen and the modalities of retreatment. A multidisciplinary committee of European experts on OA (EUROVISCO) was constituted to formulate recommendations, aimed at helping physicians in the decision-making and the optimal achievement of VS. Before each session members were tasked to collate an exhaustive literature review. Level of evidence and strength of recommendation were based on the level of agreement for each item according to the Delphi method. In 2015, a consensus position was proposed for 24 statements. Among those that obtained a consensual agreement, the working group stressed that VS is effective in mild/moderate knee OA but is not an alternative to surgery in advanced OA, and that dosing regimen must be supported by controlled trials. In 2018, two decision algorithms for the retreatment with IA-HA in knee OA were published. Among the key recommendations, the experts recommended to re-treat every year patients with high risk of OA progression, even if not symptomatic. In 2020, EUROVISCO published two sets of recommendations for the design of clinical trials on the disease-modifying effect of VS and for optimizing the results of VS. The working group underlined that an accurate analysis of radiological features and symptoms and a careful clinical examination may improve the chances of success of VS, as well as good technique of injection and the use of imaging guidance. Based on the exhaustive analysis of the literature and their own clinical experience, the EUROVISCO experts offer a wide range of recommendations intended to help practitioners, particularly in certain cases where the specific characteristics of the patients make the therapeutic decision difficult.

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“…This therapeutic modality is recommended by many scientific societies in patients with knee OA where pain is not adequately relieved with conventional therapy. [1][2][3] The success rate of VS increases when the indication is correctly set and the injection is correctly performed. 4 With the aim of increasing this success rate, the European Viscosupplementation Consensus Group (EUROVISCO) expert group has published recommendations to help practitioners using VS. [5][6][7] In September 2016, the EUROVISCO working group drew up a set of suggestions to help practitioners in the decision of retreatment with VS in patients with knee OA who have been previously treated with VS injections.…”

Section: Introductionmentioning

confidence: 99%

Retreatment with Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis: Agreement between EUROVISCO Guidelines and Current Medical Practice

Henrotin

Tits²,

Paul³

et al. 2021

CARTILAGE

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Objectives This work studied if and how current clinical practice agrees with European Viscosupplementation Consensus Group (EUROVISCO) recommendations and how this agreement might be different according to physician’s specialization. In addition, this work aimed to identify key decision factors that practitioners consider in their decision to retreat or not a patient with hyaluronic acid viscosupplementation. Methods Practitioners have been invited by e-mail to participate in an online exercise on viscosupplementation retreatment. They received a fictional patient case at random among a set of predefined fictional cases. The platform asked the practitioner if he/she would retreat the patient with viscosupplementation or not. To take a decision, the practitioner could select questions among a list of predefined questions. Among them, some were related to criteria used in the EUROVISCO decision tree and others served as confounding factors. Results A total of 506 practitioners participated to the exercise, of which 399 gave their decision about the case assigned to them by the platform. The observed agreement between practitioner decisions and EUROVISCO recommendations was 58.89 ± 4.95% (95% confidence interval [CI]). Overall, the decision to retreat was taken in 47.87% of the cases, while the EUROVISCO guidelines follow-up would have led to 55.89% retreatment for the same cases ( P = 0.03). Conclusions In current practice, physicians tended to reinject their patients less than recommended, although EUROVISCO guidelines for viscosupplementation retreatment consider decision criteria that clearly correspond to those of practitioners in real life. These include the patients’ willingness to be treated or the patients’ perception of the effectiveness of the treatment.

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Recommendations of the French Society of Rheumatology on pharmacological treatment of knee osteoarthritis

Cited by 53 publications

References 65 publications

Chondroitin Sulfate in USA Dietary Supplements in Comparison to Pharma Grade Products: Analytical Fingerprint and Potential Anti-Inflammatory Effect on Human Osteoartritic Chondrocytes and Synoviocytes

Chondroitin Sulfate in USA Dietary Supplements in Comparison to Pharma Grade Products: Analytical Fingerprint and Potential Anti-Inflammatory Effect on Human Osteoartritic Chondrocytes and Synoviocytes

Viscosupplementation for the treatment of osteoarthritis. The contribution of EUROVISCO group

Retreatment with Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis: Agreement between EUROVISCO Guidelines and Current Medical Practice

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