Treatment of osteoarthritis


Authors: K. Pavelka
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 20, 2012, No. 3, p. 138-157.
Category: Recommendation

Overview

The author presents the recommendations of the Czech Society for Rheumatology for the treatment of osteoarthritis of the knee, hip and hand joints based on the available evidence on efficacy and consensus of the committee of the Czech Society for Rheumatology. In the introductory part of the report the problems that must be resolved before determining a treatment plan for each patient are analyzed: the correct diagnosis of osteoarthritis, osteoarthritis classification (primary, secondary, monoarticular, polyarticular or generalized), the type, intensity and frequency of pain, functional limitations, structural joint damage, rate of progression of degenerative changes, another diseases of the patient, the use of medication and their possible interactions. The basic goals in the treatment of osteoarthritis include: reduction of pain and stiffness of the joint, improvement or at least maintenance of joint mobility, improvement of physical function, alleviation of disability, improvement of health-dependent quality of life, retardation of the progression of joint destruction and education of the patient about the nature of his illness and its treatment. The treatment plan should be designed individually for each patient. Optimal care is provided by several experts, in addition to a rheumatologist, a patient with osteoarthritis should be also treated by a physical therapist, orthopedic surgeon, internist and obesitologist if needed. Each patient should be treated comprehensively. Complex treatment of osteoarthritis consists of non-pharmacological treatment, pharmacological therapy and surgery if needed. Evidence-based non-pharmacological methods of treatment include patient education, lifestyle modification (weight reduction, modification of biomechanical ratios), regular exercise, some means of physical therapy and the use of prosthetic and support devices. Pharmacological treatment with evidence-based effectiveness comprise paracetamol, systemically and locally administered NSAIDs, strong and weak opioids, intra-articular glucocorticoids and some symptomatic slow-acting drugs in osteoarthritis (SYSADOA – glucosamine sulfate, diacerein, an avocado and soy extract, chondroitin sulfate and hyaluronic acid). The surgical procedures with evidence-based effectiveness include replacement of hip and knee joints, both total and unicompartmental. There is no clear evidence on the effectiveness of arthroscopic procedures such as joint lavage and debridement. Osteotomy is recommended for osteoarthritis of the hip, especially in patients with dysplasia. Osteotomy in osteoarthritis of knee joints is not included in the new EULAR recommendations. In OA of the hand joints, there is a direct evidence of effectiveness for education and exercise, NSAIDs, COX-2 inhibitors, local NSAIDs and capsaicin, and chondroitin sulfate. Acetaminophen, glucosamine and local glucocorticoids were recommended upon extrapolation from other sites.

Key words:
osteoarthritis, pharmacological treatment, total joint replacemtent


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