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Zhu S, Qu W, He C. Evaluation and management of knee osteoarthritis. J Evid Based Med 2024; 17:675-687. [PMID: 38963824 DOI: 10.1111/jebm.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
Knee osteoarthritis (KOA) significantly contributes to the global disability burden, with its incidence expected to escalate by 74.9% by 2050. The urgency to comprehend and tackle this condition is critical, necessitating an updated and thorough review of KOA. A systematic review up to February 26, 2024, has elucidated the principal aspects of KOA's pathogenesis, risk factors, clinical manifestations, and contemporary management paradigms. The origins of KOA are intricately linked to mechanical, inflammatory, and metabolic disturbances that impair joint function. Notable risk factors include age, obesity, and previous knee injuries. Diagnosis predominantly relies on clinical assessment, with radiographic evaluation reserved conditionally. The significance of rehabilitation assessments, informed by the International Classification of Functioning, Disability, and Health framework, is highlighted. Treatment strategies are diverse, prioritizing nonpharmacological measures such as patient education, exercise, and weight management, with pharmacological interventions considered adjuncts. Intra-articular injections and surgical options are contemplated for instances where conventional management is inadequate. KOA stands as a predominant disability cause globally, characterized by a complex etiology and profound effects on individuals' quality of life. Early, proactive management focusing on nonpharmacological interventions forms the cornerstone of treatment, aiming to alleviate symptoms and enhance joint function. This comprehensive review underscores the need for early diagnosis, individualized treatment plans, and the integration of rehabilitation assessments to optimize patient outcomes. Further research is needed to refine prevention strategies and improve management outcomes for KOA patients.
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Affiliation(s)
- Siyi Zhu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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El-Warrak L, Nunes M, Luna G, Barbosa CE, Lyra A, Argôlo M, Lima Y, Salazar H, de Souza JM. Towards the Future of Public Health: Roadmapping Trends and Scenarios in the Post-COVID Healthcare Era. Healthcare (Basel) 2023; 11:3118. [PMID: 38132008 PMCID: PMC10743190 DOI: 10.3390/healthcare11243118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic, a transformative event in modern society, has disrupted routine, work, behavior, and human relationships. Organizations, amidst the chaos, have innovatively adapted to the evolving situation. However, many countries were unprepared for the magnitude of the challenge, revealing the fragility of health responses due to inadequate leadership, insufficient resources, and poor information system integration. Structural changes in health systems are imperative, particularly in leadership, governance, human resources, financing, information systems, technology, and health service provision. This research utilizes the Technological Roadmapping method to analyze the health sector, focusing on public health, drawing on articles from SCOPUS and PubMed databases, and creating a roadmap extending to 2050. The research presents three long-term scenarios based on the literature-derived roadmap and explores various alternatives, including integrated care, telemedicine, Big Data utilization, nanotechnology, and Big Tech's AI services. The results underscore the anticipation of post-pandemic public health with high expectations, emphasizing the importance of integrating health history access, encouraging self-care, and leveraging technology for streamlined treatment. Practical implications include insights for decision makers and stakeholders to inform strategic planning and adapt to evolving industry demands, recognizing the significance of preventive services and the humanizing potential of technology.
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Affiliation(s)
- Leonardo El-Warrak
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Mariano Nunes
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Gabriel Luna
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Carlos Eduardo Barbosa
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
- Centro de Análises de Sistemas Navais, Rio de Janeiro 20091-000, Brazil
| | - Alan Lyra
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Matheus Argôlo
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Yuri Lima
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Herbert Salazar
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
| | - Jano Moreira de Souza
- Graduate School of Engineering (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Avenida Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Rio de Janeiro 21941-972, Brazil; (L.E.-W.); (G.L.); (Y.L.); (H.S.)
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Zhu S, Wang Z, Liang Q, Zhang Y, Li S, Yang L, He C. Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence-based practice guideline. J Evid Based Med 2023; 16:376-393. [PMID: 37743650 DOI: 10.1111/jebm.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high-quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions. METHODS Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations. RESULTS The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations). CONCLUSION This is the first evidence-based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings.
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Affiliation(s)
- Siyi Zhu
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuo Wang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiu Liang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yuting Zhang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism and Department of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Yang
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Rehabilitation Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Scheuing WJ, Reginato AM, Deeb M, Acer Kasman S. The burden of osteoarthritis: Is it a rising problem? Best Pract Res Clin Rheumatol 2023; 37:101836. [PMID: 37633827 DOI: 10.1016/j.berh.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 08/28/2023]
Abstract
The objective of this review is to provide an overview of the current status of osteoarthritis (OA) as one of the most common joint disorders worldwide. Despite being the 11th cause of disability globally, there has been an increase in the prevalence, annual incidence, and years lived with disability of OA, particularly in developed and developing countries. Erosive hand OA, which affects approximately 10% of the general population, has been associated with a higher clinical burden compared to non-erosive hand OA. Patients with knee and hip OA, but not hand OA, are also at an increased risk of cardiovascular disease and all-cause mortality. Furthermore, OA has a significant contribution to healthcare costs in most countries. The recent COVID-19 pandemic has further exacerbated the disease burden of OA patients due to limited access to medical and surgical treatment. With increasing life expectancy and the aging of the global population, the burden of OA is expected to worsen. Therefore, this review highlights the importance of improving population and policymaker awareness of risk factors, such as obesity and injury, as well as early intervention and management of OA to control the future burden of the disease.
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Affiliation(s)
| | | | - Mery Deeb
- Department of Internal Medicine, Kent Hospital/Brown University, Warwick, RI, USA.
| | - Sevtap Acer Kasman
- Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Türkiye.
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Marcelo AC, Ho EK, Hunter DJ, Hilmer SN, Jokanovic N, Prior J, Carvalho-E-Silva AP, Ferreira ML. TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis. Drugs Aging 2023; 40:343-354. [PMID: 36972011 PMCID: PMC10040925 DOI: 10.1007/s40266-023-01011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. OBJECTIVE This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. DESIGN This was an observational survey involving a consumer review panel and an HCP review panel. PARTICIPANTS 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n = 9), pharmacists (n = 7), an orthopaedic surgeon (n = 1), a rheumatologist (n = 1), nurse practitioner (n = 1) and a general practitioner (n = 1), all with at least three years of clinical experience and who reported working closely with this target patient population within the last 12 months. METHODS Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. RESULTS Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses). CONCLUSIONS This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.
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Affiliation(s)
- Alessandra C Marcelo
- The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, 2065, Australia.
| | - Emma K Ho
- The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, 2065, Australia
- The University of Sydney, Sydney Musculoskeletal Health, Charles Perkins Centre, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Eora Country, Sydney, NSW, Australia
| | - David J Hunter
- The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Medicine, Faculty of Medicine and Health, University of Sydney and the Rheumatology Department, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah N Hilmer
- Kolling Institute, Laboratory of Ageing and Pharmacology, The University of Sydney and Northern Sydney Local Health District, Reserve Road, Sydney, NSW, 2065, Australia
| | - Natali Jokanovic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joanna Prior
- The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, 2065, Australia
| | - Ana Paula Carvalho-E-Silva
- The University of Sydney, Sydney Musculoskeletal Health and John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Sydney, NSW, Australia
| | - Manuela L Ferreira
- The University of Sydney, Sydney Musculoskeletal Health and Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, 2065, Australia
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Chen C, Zhang Z, Lin M, Wang Z, Liu H, Meng H, Wang J, Chen M, Xiang S, Qiu Y, Liu H. Acupressure versus parecoxib sodium in acute renal colic: A prospective cohort study. Front Med (Lausanne) 2023; 9:968433. [PMID: 36698807 PMCID: PMC9868725 DOI: 10.3389/fmed.2022.968433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background Here provides a complementary treatment, acupressure at the Qiu acupoint, a novel acupoint, which potentially alleviates renal colic. Materials and methods 90 patients were included in this study. Acupressure-group patients (n = 46) were administered acupressure at the Qiu acupoint following a preset protocol. Parecoxib sodium-group patients (n = 44) were administered parecoxib sodium (40 mg) (via the direct intravenous route). The visual analog scale (VAS) was used to evaluate pain intensity at baseline and at 1, 5, 10, 20, 30, and 120 min after initiating the intervention. Linear mixed effects model was performed to detect the rate of decrease of VAS per time and their covariant effect on the efficacy of acupressure. Results No significant statistical differences in baseline data and VAS scores were observed. The acupressure group obtained lower VAS scores at the 1st, 5th, 10th, and 20th minute than the parecoxib sodium group after initiating the intervention (mean: 4.33 vs. 7.61, mean difference (MD): 3.29, 95% CI: 0.23, 2.84; mean: 2.65 vs. 7.61, MD: 4.96, 95% CI: 4.44, 5.49; mean: 1.63 vs. 6.59, MD: 4.96, 95% CI: 4.48, 5.44; mean: 1.26 vs. 3.64 MD: 2.38, 95% CI: 1.87, 2.88; P < 0.05). The markedly effective rate was similar between the two groups. The linear mixed effects model demonstrated that acupressure at the Qiu point was significantly faster than parecoxib sodium in decreasing VAS scores with an estimate of -2.05 (95% CI: -2.51, -1.59, p = 0.000), especially within 10 minutes with an estimate of 0.18 (95% CI: 0.12, 0.25, p = 0.000). Conclusion Acupressure at the Qiu acupoint is significantly faster than parecoxib sodium in decreasing VAS scores within 10 minutes. Clinical trial registration http://www.chictr.org.cn/, identifier 2100047168.
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Affiliation(s)
- Chiwei Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenpeng Zhang
- Shenzhen Hospital (Longgang), Beijing University of Traditional Chinese Medicine, Shenzhen, Guangdong, China
| | - Mandi Lin
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhigang Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Meng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jun Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ming Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Songtao Xiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,*Correspondence: Songtao Xiang,
| | - Yunqiao Qiu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Yunqiao Qiu,
| | - Hong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China,Hong Liu,
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Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial. Biomedicines 2022; 11:biomedicines11010004. [PMID: 36672512 PMCID: PMC9855334 DOI: 10.3390/biomedicines11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The study’s objective was to develop a clinical prediction rule that predicts a clinically significant analgesic effect on chronic knee osteoarthritis pain after transcranial direct current stimulation treatment. This is a secondary analysis from a double-blind randomized controlled trial. Data from 51 individuals with chronic knee osteoarthritis pain and an impaired descending pain inhibitory system were used. The intervention comprised a 15-session protocol of anodal primary motor cortex transcranial direct current stimulation. Treatment success was defined by the Western Ontario and McMaster Universities’ Osteoarthritis Index pain subscale. Accuracy statistics were calculated for each potential predictor and for the final model. The final logistic regression model was statistically significant (p < 0.01) and comprised five physical and psychosocial predictor variables that together yielded a positive likelihood ratio of 14.40 (95% CI: 3.66−56.69) and an 85% (95%CI: 60−96%) post-test probability of success. This is the first clinical prediction rule proposed for transcranial direct current stimulation in patients with chronic pain. The model underscores the importance of both physical and psychosocial factors as predictors of the analgesic response to transcranial direct current stimulation treatment. Validation of the proposed clinical prediction rule should be performed in other datasets.
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ABBOTT A, GUSTAFSSON K, ZHOU C, ROLFSON O, SVENSSON GL. Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking. Acta Orthop 2022; 93:51-58. [PMID: 34678106 PMCID: PMC8815318 DOI: 10.1080/17453674.2021.1992932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and-if necessary-weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008-2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008-2012) compared with after (2012-2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods - Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results - Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2-5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs -8.6% (CI -9.6 to -7.6), weak opioids -6.8% (CI -7.7 to -5.9), glucosamine -9.5% (CI -9.8 to -8.8). and hyaluronic acid -1.6% (CI -1.8 to -1.5) but discordantly increased for strong opioids 2.8% (CI 2.1-3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0-3.1). Interpretation - In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes nonpharmacological before pharmacological interventions. Additional modest improvements occurred in the steppedcare prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.
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Affiliation(s)
- Allan ABBOTT
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
| | - Kristin GUSTAFSSON
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping,Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping
| | - Caddie ZHOU
- Centre of Registries Västra Götaland, Gothenburg
| | - Ola ROLFSON
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg
| | - Gunilla Limbäck SVENSSON
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg,BOA Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden
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Wallis JA, Barton CJ, Brusco NK, Kemp JL, Sherwood J, Young K, Jennings S, Trivett A, Ackerman IN. Exploring views of orthopaedic surgeons, rheumatologists and general practitioners about osteoarthritis management. Musculoskeletal Care 2021; 19:524-532. [PMID: 33710743 PMCID: PMC9292668 DOI: 10.1002/msc.1549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Delivery of recommended treatments for hip and knee osteoarthritis (OA) is known to be discordant with guideline recommendations. However, professional views related to OA management across medical and surgical disciplines are not well understood. The aim of this study was to explore the views of medical professionals about management of hip and knee OA. METHODS Qualitative study. Semistructured individual interviews were conducted with orthopaedic surgeons, rheumatologists and general practitioners routinely involved in the management of OA. Interviews were audiotaped, transcribed, member-checked, coded and thematically analysed. RESULTS Fifteen medical professionals were interviewed. Three main themes were: (i) recognition of the importance of nonsurgical management of hip and knee OA, focussed on self-management, exercise-therapy, weight management and analgesia; (ii) joint replacement being considered the 'last resort' for end stage disease not responding to nonsurgical management; and (iii) determination of management 'success' through patient perceptions was more common than the use of validated instruments. Views on management broadly converged across disciplines, except for the role of joint replacement, considered an adjunct in the overall management of OA by rheumatologists and as a definitive cure by orthopaedic surgeons. CONCLUSIONS Aligning with current guidelines, medical professionals recognised the importance of nonsurgical management focussed on exercise-therapy for hip and knee OA, and concurred that joint replacement surgery should be a last resort. A focus on patient education was less prominent, which along with implementation of validated outcome measures in routine medical practice, may require greater health system support.
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Affiliation(s)
- Jason A. Wallis
- Centre for Allied Health Research and EducationCabrini HealthMalvernVictoriaAustralia
- Monash Department of Clinical EpidemiologyCabrini InstituteMalvernVictoriaAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied Health, Human Services and SportLa Trobe UniversityBundooraVictoriaAustralia
- Department of SurgerySt Vincent's HospitalThe University of MelbourneFitzroyVictoriaAustralia
| | - Natasha K. Brusco
- Centre for Allied Health Research and EducationCabrini HealthMalvernVictoriaAustralia
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreSchool of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied Health, Human Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - James Sherwood
- Centre for Allied Health Research and EducationCabrini HealthMalvernVictoriaAustralia
| | - Kirby Young
- Centre for Allied Health Research and EducationCabrini HealthMalvernVictoriaAustralia
| | - Sophie Jennings
- Centre for Allied Health Research and EducationCabrini HealthMalvernVictoriaAustralia
| | - Adrian Trivett
- Department of Orthopaedic SurgeryCabrini HealthMalvernVictoriaAustralia
| | - Ilana N. Ackerman
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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D'Angelo D, Coclite D, Napoletano A, Fauci AJ, Latina R, Gianola S, Castellini G, Salomone K, Gambalunga F, Sperati F, Iacorossi L, Iannone P. The efficacy of balneotherapy, mud therapy and spa therapy in patients with osteoarthritis: an overview of reviews. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1255-1271. [PMID: 33740137 DOI: 10.1007/s00484-021-02102-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Osteoarthritis is a degenerative disease considered a leading cause of functional disability. Its treatment is based on a combination of pharmacological and non-pharmacological interventions, but the role of these latter is still debated. This overview of systematic reviews aimed at evaluating the short-term efficacy of different thermal modalities in patients with osteoarthritis. We searched PubMed, Scopus, CINHAL, Web of Science, ProQuest and the Cochrane Database of Systematic Reviews from inception until October 2020, with no language restrictions. We selected the following outcomes a priori: pain, stiffness and quality of life. Seventeen systematic reviews containing 27 unique relevant studies were included. The quality of the reviews ranged from low to critically low. Substantial variations in terms of interventions studied, comparison groups, population, outcomes and follow-up between the included SRs were found. From a re-analysis of primary data, emerged that balneotherapy was effective in reducing pain and improving stiffness and quality of life, mud therapy significantly reduced pain and stiffness, and spa therapy showed pain relief. However, the evidence supporting the efficacy of different thermal modalities could be seriously flawed due to methodological quality and sample size, to the presence of important treatment variations, and to the high level of heterogeneity and the absence of a double-blind design. There is some encouraging evidence that deserves clinicians' consideration, suggesting that thermal modalities are effective on a short-term basis for treating patients with AO.
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Affiliation(s)
- Daniela D'Angelo
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Daniela Coclite
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Antonello Napoletano
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Alice Josephine Fauci
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Roberto Latina
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Katia Salomone
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
| | | | - Francesca Sperati
- Biostatistics and Bioinformatic Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Iacorossi
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy.
| | - Primiano Iannone
- National Center for Clinical Excellence, Healthcare Quality and Safety, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162, Rome, Italy
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van den Driest JJ, Schiphof D, de Wilde M, Bindels PJE, van der Lei J, Bierma-Zeinstra SMA. Antidepressant and anticonvulsant prescription rates in patients with osteoarthritis: a population-based cohort study. Rheumatology (Oxford) 2021; 60:2206-2216. [PMID: 33175150 PMCID: PMC8121444 DOI: 10.1093/rheumatology/keaa544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives There are signs that antidepressants and anticonvulsants are being prescribed more often for OA patients, despite limited evidence. Our objectives were to examine prescription rates and time trends for antidepressants and anticonvulsants in OA patients, to assess the percentage of long-term prescriptions, and to determine patient characteristics associated with antidepressant or anticonvulsant prescription. Methods A population-based cohort study was conducted using the Integrated Primary Care Information database. First, episodic and prevalent prescription rates for antidepressants (amitriptyline, nortriptyline and duloxetine) and anticonvulsants (gabapentinoids) in OA patients were calculated for the period 2008–17. Logistic regression was used to assess which patient characteristics were associated with prescriptions. Results In total, 164 292 OA patients were included. The prescription rates of amitriptyline, gabapentin and pregabalin increased over time. The increase in prescription rates for pregabalin was most pronounced. Episodic prescription rate increased from 7.1 to 13.9 per 1000 person-years between 2008 and 2017. Amitriptyline was prescribed most (15.1 episodic prescriptions per 1000 person-years in 2017). Prescription rates of nortriptyline and duloxetine remained stable at 3.0 and 2.0 episodic prescriptions per 1000 person-years, respectively. For ≤3% of patients with incident OA, medication was prescribed long-term (≥3 months). In general, all medication was prescribed more frequently for older patients (except duloxetine), women, patients with OA in ≥2 joints, patients with spinal OA and patients with musculoskeletal disorders. Conclusion Prescription rates of amitriptyline, gabapentin and pregabalin increased over time. Since there is little evidence to support prescription in OA, caution is necessary when prescribing.
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Affiliation(s)
| | | | | | | | | | - Sita M A Bierma-Zeinstra
- Department of General Practice.,Department of Orthopedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Fargesin ameliorates osteoarthritis via macrophage reprogramming by downregulating MAPK and NF-κB pathways. Arthritis Res Ther 2021; 23:142. [PMID: 33990219 PMCID: PMC8120707 DOI: 10.1186/s13075-021-02512-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background To investigate the role and regulatory mechanisms of fargesin, one of the main components of Magnolia fargesii, in macrophage reprogramming and crosstalk across cartilage and synovium during osteoarthritis (OA) development. Methods Ten-week-old male C57BL/6 mice were randomized and assigned to vehicle, collagenase-induced OA (CIOA), or CIOA with intra-articular fargesin treatment groups. Articular cartilage degeneration was evaluated using the Osteoarthritis Research Society International (OARSI) score. Immunostaining and western blot analyses were conducted to detect relative protein. Raw264.7 cells were treated with LPS or IL-4 to investigate the role of polarized macrophages. ADTC5 cells were treated with IL-1β and conditioned medium was collected to investigate the crosstalk between chondrocytes and macrophages. Results Fargesin attenuated articular cartilage degeneration and synovitis, resulting in substantially lower Osteoarthritis Research Society International (OARSI) and synovitis scores. In particular, significantly increased M2 polarization and decreased M1 polarization in synovial macrophages were found in fargesin-treated CIOA mice compared to controls. This was accompanied by downregulation of IL-6 and IL-1β and upregulation of IL-10 in serum. Conditioned medium (CM) from M1 macrophages treated with fargesin reduced the expression of matrix metalloproteinase-13, RUNX2, and type X collagen and increased Col2a1 and SOX9 in OA chondrocytes, but fargesin alone did not affect chondrocyte catabolic processes. Moreover, fargesin exerted protective effects by suppressing p38/ERK MAPK and p65/NF-κB signaling. Conclusions This study showed that fargesin switched the polarized phenotypes of macrophages from M1 to M2 subtypes and prevented cartilage degeneration partially by downregulating p38/ERK MAPK and p65/NF-κB signaling. Targeting macrophage reprogramming or blocking the crosstalk between macrophages and chondrocytes in early OA may be an effective preventive strategy.
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Rejas-Gutierrez J, Sicras-Mainar A, Darbà J. Future projections of opioid use and cost in patients with chronic osteoarthritis pain in Spain. Ther Adv Musculoskelet Dis 2021; 13:1759720X211010599. [PMID: 33995603 PMCID: PMC8107672 DOI: 10.1177/1759720x211010599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Opioids are widely used in moderate-to-severe chronic pain which is non-responsive to standard analgesics. Prescriptions have increased in Europe in the last decade, although remain lower than in USA. This work projected the future utilization and costs of opioids in chronic osteoarthritis (OA) pain in the Spanish National Health System (NHS). METHODS An epidemiological model was populated with the opioid dispensing trends from 2010 to 2019 using Spanish Medicinal Agency rates of opioid utilization in subjects over 18 years of age and the real-world OPIOIDS study to estimate chronic-OA-pain patients receiving opioids. A best-fitted trend analysis model was applied estimating the likely number of DHD (defined daily dose/1000 inhabitants per day) to calculate projected opioid utilization and costs for the period 2020-2029. RESULTS In 2010, an estimated 5.67 DHD were dispensed for the equivalent of 217,076 chronic OA pain patients per day [1.99 DHD, 76,084 refractory to non-steroidal anti-inflammatory drugs (NSAIDs)]. From these trends and OA prevalence, the projected number of DHDs is expected to increase more than threefold to 17.98 DHDs by the year 2029 for the equivalent of 727,356 chronic OA pain patients per day (8.18 DHD, 330,720 refractory to NSAIDs); 41.8% on strong opioids. The estimated cost was €116.9m (€45.0m in NSAID-refractory OA) in 2010 rising by 222% to €376.1m (€199.7m refractory to NSAIDs) by 2029. CONCLUSION Chronic-OA-pain-related opioid dispensing and costs to the NHS are set to increase more than threefold from 2010 to 2029 in Spain. Using opioids for OA pain is concerning given disease chronicity and other related costs not computed in these projections. PLAIN LANGUAGE SUMMARY • Opioids are widely used in chronic pain which is non-responsive to standard analgesics. Prescriptions have increased in Europe, although remain lower than in USA. Osteoarthritis (OA) is a degenerative joint disease usually accompanied by pain. Despite not recommended, opioids use in OA have been expanded because this health condition is increasing with ageing and, also, because physicians both primary and specialist boosted their use.• This study aimed to quantify the current burden of opioids used for chronic moderate-to-severe OA pain by estimating the number of defined daily doses per 1000 inhabitants per day (DHD) and associated costs, and to forecast the likely burden on the National Health System (NHS) in Spain for the years 2020-2029.• In 2010, an estimated 5.67 DHDs were dispensed for the equivalent of 217,076 chronic OA pain patients per day. From these trends, the projected number of DHDs is expected to increase more than threefold to 17.98 DHDs by the year 2029 for the equivalent of 727,356 chronic OA pain patients per day; 41.8% on strong opioids. The estimated cost was €116.9m in 2010 rising by 222% to €376.1m by 2029.• Chronic OA-pain-related opioid dispensing and costs to the NHS are set to increase substantially (threefold to more than fourfold) from 2010 to 2029 in Spain. Thus, using opioids for OA pain is concerning given disease chronicity, aging population and other related costs not computed in these projections. Our findings can inform payors and clinicians about ongoing discussions on appropriate analgesic management for longer-term OA pain, including resource requirements at a national level. Clinicians who prescribe opioids for OA pain should consider the potential implications of side effects such as sedation, cognitive deterioration, incremental need of caregivers, particularly in older people, and carefully consider the risk-benefit balance.
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Affiliation(s)
- Javier Rejas-Gutierrez
- Department of Pharmacoeconomics and Health Outcomes Research, Pfizer, S.L.U., Avda. de Europa, 20-B, Parque Empresarial La Moraleja, Alcobendas, Madrid 28108, Spain
| | - Antoni Sicras-Mainar
- Health Economics and Outcomes Research, Atrys Health, Badalona, Barcelona, Spain
| | - Josep Darbà
- Department of Economics, Universidad de Barcelona, Barcelona, Spain
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14
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Sicras-Mainar A, Rejas-Gutierrez J, Vargas-Negrín F, Tornero-Tornero JC, Sicras-Navarro A, Lizarraga I. Disease Burden and Costs in Moderate-to-Severe Chronic Osteoarthritis Pain Refractory to Standard of Care: Ancillary Analysis of the OPIOIDS Real-World Study. Rheumatol Ther 2021; 8:303-326. [PMID: 33411324 PMCID: PMC7991059 DOI: 10.1007/s40744-020-00271-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To determine the disease burden and costs in moderate-to-severe chronic osteoarthritis (OA) pain refractory to standard-of-care treatment in the Spanish National Health System (NHS). METHODS Ancillary analysis of the OPIOIDS real-world, non-interventional, retrospective, 4-year longitudinal study including patients aged at least 18 years with moderate-to-severe chronic OA pain refractory to standard-of-care with sequential NSAIDs plus opioids. Burden assessment included measurement of analgesia, cognitive functioning, basic activities of daily living, severity and frequency of comorbidities, and all-cause mortality. Costs accounted for healthcare resource utilization and related costs (year 2018). RESULTS Records of 13,317 patients were analyzed; 68.9 (14.7) years old, 71.3% (70.5-72.1%) women, 58.1% refractory to NSAID plus weak opioid and 41.9% to NSAID plus strong opioid, accounting for 10.7% (10.5-10.8%) of patients with chronic OA pain. Mean number of comorbidities was 2.9 (1.8) and its severity was 1.8 (1.7). Pain decreased by 0.9 points (12.2%) and cognitive declined by 2.3 points (9.1%, with 4.3% more patients with cognitive deficit) and dependency worsened by 0.4 points (0.5%, with 2.3% more patients with severe-to-total dependence) over a mean treatment period of 188.6 (185.4-191.8) days on NSAIDs followed by 400.6 (393.7-407.5) days on opioids. The adjusted mortality rate was higher in patients with OA taking NSAID plus strong opioids; hazard ratio 1.44 (1.26-1.65; p < 0.001). The 4-year healthcare cost was €7350/patient (€7193-7507 or €1838/year) and was higher in those taking strong versus weak opioids; €9886 (€9608-10,164, €2472/year) vs. €5519 (€5349-5689, €1380/year), p < 0.001. Analgesia cost (16.0% of total cost, 70.2% opioids) was higher with strong versus weak opioids, 19.6% vs. 11.3%, p < 0.001. CONCLUSIONS In routine clinical practice in Spain, patients with moderate-to-severe chronic OA pain refractory to standard analgesic treatment with NSAIDs plus opioids reported modest reductions in pain, while presenting a considerable burden of comorbidities, cognitive impairment, and dependency. Healthcare costs significantly increased for the NHS particularly with NSAIDs plus strong opioids.
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15
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van den Driest JJ, Schiphof D, de Wilde M, Bindels PJE, van der Lei J, Bierma-Zeinstra SMA. Opioid prescriptions in patients with osteoarthritis: a population-based cohort study. Rheumatology (Oxford) 2021; 59:2462-2470. [PMID: 31960046 PMCID: PMC7449800 DOI: 10.1093/rheumatology/kez646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids were assessed. METHODS A population-based cohort study was conducted using the Integrated Primary Care Information database. Incidence and prevalence of opioid prescriptions were calculated for the period 2008-2017. Logistic regression was used to assess which patient characteristics were associated with opioid prescriptions. RESULTS In total, 157 904 OA patients were included. The overall prescription rate remained fairly stable, at around 100 incident and 170 prevalent prescriptions per 1000 person years. However, the incident prescription rate for oxycodone increased from 7.1 to 40.7 per 1000 person years and for fentanyl from 4.2 to 7.4 per 1000 person years. The incident prescription rate for paracetamol/codeine decreased from 63.0 to 13.3 per 1000 person years. Per follow-up year, long-term use was found in 3% of the patients with incident OA. Finally, factors associated with more prescriptions were increasing age, OA in ≥2 joint groups [odds ratio (OR) 1.56; 95% CI: 1.51, 1.65] and the presence of other musculoskeletal disorders (OR 4.91; 95% CI: 4.76, 5.05). Men were less likely to be prescribed opioids (OR 0.78; 95% CI: 0.76, 0.80). CONCLUSION Prescription rates for opioids remained stable, but types of opioids prescribed changed. Oxycodone and fentanyl were increasingly prescribed, while prescriptions of paracetamol/codeine decreased. Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution.
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Affiliation(s)
- Jacoline J van den Driest
- Department of General PracticeErasmus MC, University Medical Center, Rotterdam, The Netherlands
- Correspondence to: J. J. van den Driest, Department of General Practice, Erasmus MC, Wytemaweg 80, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail:
| | - Dieuwke Schiphof
- Department of General PracticeErasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marcel de Wilde
- Department of Medical Informatics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General PracticeErasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General PracticeErasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics, University Medical Center, Erasmus MC, Rotterdam, The Netherlands
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16
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Pongratz G. [Pain in rheumatic diseases : What can biologics and JAK inhibitors offer?]. Z Rheumatol 2021; 80:214-225. [PMID: 33443608 DOI: 10.1007/s00393-020-00957-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/25/2022]
Abstract
Persistent pain despite adequate inflammation control poses a big challenge in many rheumatic diseases for patients as well as physicians. The focus of drug development over the past years was on anti-inflammatory therapies. Enormous progress has been made and several treatment options have been added. It has been observed that pain triggered by inflammation can be effectively treated by inflammation control; however, the chronic pain component remains a problem, is little studied and specific treatment options are missing. Pain is influenced by inflammatory mediators, such as cytokines, which act on peripheral nociceptors and lead to peripheral sensitization. If inflammation continues, this can potentially lead to central sensitization and chronification of pain via immigration of immune cells and/or local activation of e.g. microglia. This leads to increasing autonomization and uncoupling of pain from the actual inflammatory process. The present review deals with the question if bDMARD or tsDMARD also show benefits concerning pain processes in addition to the profound inhibitory effects on inflammation. There are preclinical data that show an influence on sensitization following the use of cytokine inhibitors. On the other hand, so far clinical data show that bDMARDs as well as tsDMARDs consistently rapidly and reliably reduce nociceptive inflammatory pain across disease entities. An effect especially on the process of central sensitization and therefore on chronification of pain cannot be finally evaluated based on the currently available data.
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Affiliation(s)
- G Pongratz
- Poliklink, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Sicras-Mainar A, Tornero-Tornero C, Vargas-Negrín F, Lizarraga I, Rejas-Gutierrez J. Health outcomes and costs in patients with osteoarthritis and chronic pain treated with opioids in Spain: the OPIOIDS real-world study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20942000. [PMID: 32994809 PMCID: PMC7502862 DOI: 10.1177/1759720x20942000] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: The objective of this study was to analyze health outcomes, resource utilization, and costs in osteoarthritis patients with chronic nociceptive pain who began treatment with an opioid in real-world practice in Spain. Methods: We designed a non-interventional, retrospective, longitudinal study with 36 months of follow-up using electronic medical records (EMRs) from primary care centers, of patients aged 18+ years who began a new treatment with an opioid drug in usual practice for chronic pain due to osteoarthritis. Health/non-health resource utilization and costs, treatment adherence, pain change, cognitive functioning, and dependence for basic activities of daily living (BADL) were assessed. Results: A total of 38,539 EMRs [mean age (SD); 70.8 (14.3) years, 72.3% female; 53.3% hip/knee, 25.0% spine, and 21.7% other sites] were recruited. A total of 19.1% of patients remained on initial opioid at 36 months, without significant differences by osteoarthritis site (p = 0.125). Mean total adjusted cost was €17,915, with 27.7% corresponding to healthcare resources and 72.3% to lost productivity. Hospital admissions for osteoarthritis-related surgical interventions accounted for 15.8% of total healthcare cost. A slight mean pain reduction was observed: –1.3 points, –16.9%, p < 0.001, with increases in cognitive deficit (+3.3%, p < 0.001) and moderate to total dependence for BADL (+15.6%, p < 0.001) in a median duration of opioid use of 203 days (IQR: 89–696). Conclusions: In real-world practice in Spain, opioid use in osteoarthritis was high, but with low adherence. There were meaningful increases in resource use and costs for the National Health System. Pain reduction was modest, whereas cognitive impairment and dependence for BADL increased significantly.
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Affiliation(s)
- Antoni Sicras-Mainar
- Health Economics and Outcomes Research, Real Life Data SLU. Edifici BCIN, Carrer Marcus Porcius, núm. 1, Polígon les Guixeres, Badalona, Barcelona 08915, Spain
| | - Carlos Tornero-Tornero
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Are medical comorbidities contributing to the use of opioid analgesics in patients with knee osteoarthritis? Osteoarthritis Cartilage 2020; 28:1030-1037. [PMID: 32387761 DOI: 10.1016/j.joca.2020.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although opioid analgesics are not generally recommended for treatment of knee osteoarthritis (OA), they are frequently used. We sought to determine the association between medical comorbidities and self-reported opioid analgesic use in these patients. METHODS This cross-sectional study recruited patients referred to two provincial hip and knee clinics in Alberta, Canada for consideration of total knee arthroplasty. Standardized questionnaires assessed demographic (age, gender, income, education, social support, smoking status) and clinical (pain, function, total number of troublesome joints) characteristics, comorbid medical conditions, and non-surgical OA management participants had ever used or were currently using. Multivariable Poisson regression with robust estimate of the standard errors assessed the association between comorbid medical conditions and current opioid use, controlling for potential confounders. RESULTS 2,127 patients were included: mean age 65.4 (SD 9.1) years and 59.2% female. Currently used treatments for knee OA were: 57.6% exercise and/or physiotherapy, 61.1% NSAIDs, and 29.8% opioid analgesics. In multivariable regression, controlling for potential confounders, comorbid hypertension (RR 1.18, 95% CI 1.02-1.37), gastrointestinal disease (RR 1.31, 95% CI 1.07-1.60), depressed mood (RR 1.25, 95% CI 1.05-1.48) and a higher number of troublesome joints (RR 1.04 per joint, 95% CI 1.00-1.09) were associated with opioid use, with no association found with having ever used recommended non-opioid pharmacological or non-pharmacological treatments. CONCLUSIONS In a large cohort of patients with knee OA, of 12 comorbidities assessed, comorbid hypertension, gastrointestinal disease, and depressed mood were associated with current use of opioid analgesics, in addition to total burden of troublesome joints. Improved guidance on the management of painful OA in the setting of common comorbidities is warranted.
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US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Eur Radiol 2020; 30:3996-4004. [PMID: 32140818 DOI: 10.1007/s00330-020-06749-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA) through a 5-year follow-up. METHODS Overall, 472 participants and 944 knees were eligible. MME (mm) was measured at the baseline, and KOA was radiographically evaluated at both baseline and 5-year follow-up by Kellgren-Lawrence grade (KLG). Radiographic KOA (ROA) was defined as the knee showing KLG ≥ 2. Incident ROA (iROA) was defined if the baseline KLG of 0-1 increased to KLG ≥ 2 in 5 years. Progressive ROA (pROA) was defined if the baseline KLG of 2-3 worsened to a higher grade in 5 years. Receiver operating characteristic (ROC) curve and generalized estimating equations were used for analysis. RESULTS Of 574 non-ROA knees at the baseline, 43 knees (7.5%) developed iROA; of 370 ROA knees, 47 knees (12.7%) developed pROA. Based on the ROC curves, 4 mm was the optimal cutoff to detect the risk of iROA (area under curve [AUC] 0.639 [right knee]; AUC 0.641 [left knee]) and that of pROA (AUC 0.750 [right knee]; AUC 0.863 [left knee]). Multiple regression analysis showed that the 4-mm cutoff of MME was significantly associated with both the prevalence of iROA (regression coefficient [B] 1.909; p ≤ 0.001; adjusted odds ratio [aOR] 6.746) and that of pROA (B 1.791; p ≤ 0.001; aOR 5.993). CONCLUSIONS On ultrasonography, the participants with more extruded medial meniscus showed a higher prevalence of both iROA and pROA. Ultrasonography could identify patients who had a risk of developing KOA. KEY POINTS • Through a 5-year follow-up, the current cohort study was conducted to clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA). • More extruded medial meniscus evaluated by ultrasonography was associated with the development of radiographic KOA. • Ultrasonography could identify the patients who had a risk of developing KOA, and the 4-mm cutoff of MME was optimal to detect this risk.
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Thorlund JB, Turkiewicz A, Prieto-Alhambra D, Englund M. Inappropriate opioid dispensing in patients with knee and hip osteoarthritis: a population-based cohort study. Osteoarthritis Cartilage 2020; 28:146-153. [PMID: 31669311 DOI: 10.1016/j.joca.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate inappropriate opioid dispensing in patients with knee or hip osteoarthritis (OA) defined as (1) dispensing of opioids within the first year of diagnosis or (2) long-term opioid use. DESIGN Data from Skåne Healthcare Register was linked with the Swedish Prescribed Drug Register. Incidence proportion of dispensed opioids within first year of incident knee or hip OA diagnosis was determined in knee (n = 399,670) and hip (413,216) OA cohorts without a history of OA. The 1-year period prevalence of long-term opioid dispensing was determined in a prevalence cohort (n = 48,574 with knee and/or hip OA and n = 457,587 without OA). The proportion of OA patients with excess opioid dispensing attributable to OA was estimated using inverse probability weighted regression adjustment. RESULTS In the incident cohorts, 5866 and 2359 developed knee and hip OA, respectively. Within the first year after OA diagnosis 14.7% patients with knee OA and 20.7% with hip OA had an opioid dispensed. The estimated inappropriate dispensing attributable to OA was 7.4% (95% CI 6.5-8.4) for knee OA and 12.8% (95% CI 11.1-14.4) for hip OA. Among persons with prevalent knee, hip or knee and hip OA inappropriate, long-term opioid use attributable to OA was 1.3%, 2.0% and 2.4% of, respectively. CONCLUSIONS More than half the incident opioid dispensations to patients within their first year after knee or hip OA diagnosis are inappropriate according to current treatment guidelines. Furthermore, 2% of patients with prevalent knee or hip OA have inappropriate long-term dispensing of opioids.
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Affiliation(s)
- J B Thorlund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden
| | - D Prieto-Alhambra
- GREMPAL (Grup de Recerca en Epidemiologia de les Malalties Prevalents de l'Aparell Locomotor), Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, UK
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Understanding the Molecular Mechanisms Underlying the Pathogenesis of Arthritis Pain Using Animal Models. Int J Mol Sci 2020; 21:ijms21020533. [PMID: 31947680 PMCID: PMC7013391 DOI: 10.3390/ijms21020533] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Arthritis, including osteoarthritis (OA) and rheumatoid arthritis (RA), is the leading cause of years lived with disability (YLD) worldwide. Although pain is the cardinal symptom of arthritis, which is directly related to function and quality of life, the elucidation of the mechanism underlying the pathogenesis of pain in arthritis has lagged behind other areas, such as inflammation control and regulation of autoimmunity. The lack of therapeutics for optimal pain management is partially responsible for the current epidemic of opioid and narcotic abuse. Recent advances in animal experimentation and molecular biology have led to significant progress in our understanding of arthritis pain. Despite the inherent problems in the extrapolation of data gained from animal pain studies to arthritis in human patients, the critical assessment of molecular mediators and translational studies would help to define the relevance of novel therapeutic targets for the treatment of arthritis pain. This review discusses biological and molecular mechanisms underlying the pathogenesis of arthritis pain determined in animal models of OA and RA, along with the methodologies used.
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Donec V, Kubilius R. The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial. Ther Adv Musculoskelet Dis 2019; 11:1759720X19869135. [PMID: 31497072 PMCID: PMC6716177 DOI: 10.1177/1759720x19869135] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Kinesio Taping® method is a nonpharmacological alternative for pain
management in musculoskeletal disorders. However, the existing evidence is
insufficient to assess its full effectiveness for pain management in knee
osteoarthritis (KO). Our aim was to evaluate the effectiveness of the
Kinesio Taping method in reducing knee pain for KO patients. Methods: In this randomized, double blind, controlled trial, we recruited 187 patients
with grade I-III KO who were allocated to either the Kinesio Taping or
control group. The study was carried out in outpatient facility. Either
Kinesio Taping or nonspecific taping was applied on the affected knee area
for 4 weeks. Pain evaluation was performed at baseline, after 1 month of
taping and after 1 further month without taping. The data on usage of
painkillers were collected; Numeric Pain Rating Scale; an algometer, and
Knee injury and Osteoarthritis Outcome Scores (KOOS) pain subscale were used
to assess pain. Tolerance and subjective opinions toward the effectiveness
of taping were evaluated. The chosen level of significance was
p < 0.05, ß ⩽ 0.2. Results: The majority (>70%) of both groups’ patients indicated that tapes reduced
the knee pain. The reported use of painkillers decreased, in addition to
self-reported increase in the KOOS subscale, thereby indicating pain
alleviation. All self-reported improvement remained at the 1-month follow up
(p < 0.05). Significantly higher and clinically
meaningful reduction of pain intensity was found in the Kinesio Taping group
after the treatment month, in comparison with the control group
(p < 0.05). More pain reduction was reported in the
daytime for participants in the Kinesio Taping group at the follow up
(p = 0.022). No changes in algometry results were
observed. Conclusions: Elastic taping can safely relieve knee pain and reduce the need for
pharmacological management in KO. A specific Kinesio Taping technique is
clinically more beneficial for knee-pain alleviation in comparison with
nonspecific taping. [ClinicalTrials.gov identifier: NCT03076177.]
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Affiliation(s)
- Venta Donec
- Rehabilitation Department, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009, Kaunas 44307, Lithuania
| | - Raimondas Kubilius
- Rehabilitation Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Zhao S, Chen F, Feng A, Han W, Zhang Y. Risk Factors and Prevention Strategies for Postoperative Opioid Abuse. Pain Res Manag 2019; 2019:7490801. [PMID: 31360271 PMCID: PMC6652031 DOI: 10.1155/2019/7490801] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Abstract
Worldwide, 80% of patients who undergo surgery receive opioid analgesics as the fundamental agent for pain relief. However, the irrational use of opioids leads to excessive drug dependence and drug abuse, resulting in an increased mortality rate and huge economic loss. The crisis of opioid overuse remains a great challenge. In this review, we summarize several key factors in opioid abuse, including race, region, income, genetic factors, age and gender, smoking and alcohol abuse, history of chronic pain and analgesic drug abuse, surgery, neuropsychiatric illness, depression and antidepressant use, human factors, national policies, hospital regulations, and health insurance under treatment of pain. Furthermore, we present several prevention strategies, such as perioperative measures, opioid substitutes, treatment of the primary illness, emotional regulation, use of opioid antagonists, efforts of the state, hospitals, doctors and pharmacy benefit managers, gene therapy, and vaccines. Greater understanding and better assessment are required of the risks associated with opioid abuse to ensure the safety and analgesic effects of pain treatment after surgery.
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Affiliation(s)
- Shuai Zhao
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, China
| | - Fan Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Anqi Feng
- Department of Anesthesiology, Second Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Han
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, China
| | - Yuan Zhang
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, China
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Abstract
Supplemental Digital Content is Available in the Text. Anxiety predicts onset of knee pain and drives greater osteoarthritis pain in humans. Our validated preclinical model identifies supraspinal astrocytosis as a potential mechanism. Anxiety and depression are associated with increased pain responses in chronic pain states. The extent to which anxiety drives chronic pain, or vice versa, remains an important question that has implications for analgesic treatment strategies. Here, the effect of existing anxiety on future osteoarthritis (OA) pain was investigated, and potential mechanisms were studied in an animal model. Pressure pain detection thresholds, anxiety, and depression were assessed in people with (n = 130) or without (n = 100) painful knee OA. Separately, knee pain and anxiety scores were also measured twice over 12 months in 4730 individuals recruited from the general population. A preclinical investigation of a model of OA pain in normo-anxiety Sprague-Dawley (SD) and high-anxiety Wistar Kyoto (WKY) rats assessed underlying neurobiological mechanisms. Higher anxiety, independently from depression, was associated with significantly lower pressure pain detection thresholds at sites local to (P < 0.01) and distant from (P < 0.05) the painful knee in patients with OA. Separately, high anxiety scores predicted increased risk of knee pain onset in 3274 originally pain-free people over the 1-year period (odds ratio = 1.71; 95% confidence interval = 1.25-2.34, P < 0.00083). Similarly, WKY rats developed significantly lower ipsilateral and contralateral hind paw withdrawal thresholds in the monosodium iodoacetate model of OA pain, compared with SD rats (P = 0.0005). Linear regressions revealed that baseline anxiety-like behaviour was predictive of lowered paw withdrawal thresholds in WKY rats, mirroring the human data. This augmented pain phenotype was significantly associated with increased glial fibrillary acidic protein immunofluorescence in pain-associated brain regions, identifying supraspinal astrocyte activation as a significant mechanism underlying anxiety-augmented pain behaviour.
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Thorlund JB, Turkiewicz A, Prieto-Alhambra D, Englund M. Opioid use in knee or hip osteoarthritis: a region-wide population-based cohort study. Osteoarthritis Cartilage 2019; 27:871-877. [PMID: 30682417 DOI: 10.1016/j.joca.2019.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/07/2018] [Accepted: 01/08/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify opioid use in knee and hip osteoarthritis (OA) patients, and to estimate the proportion of opioids in the population attributable to OA patients. DESIGN Population-based cohort study. METHODS We included 751,579 residents in southern Sweden, aged ≥35 years in 2015. Doctor-diagnosed knee or hip OA between 1998 and 2015 was the exposure. Dispensed weak and strong opioids were identified between November 2013 and October 2015 from the Swedish Prescribed Drug Register (SPDR). We determined age- and sex-standardized 12-month period prevalence of opioid use from November 2014 until October 2015 and calculated prevalence ratios and incidence rate ratios adjusted for age, sex, and other socio-demographic variables. We estimated the population attributable fraction (PAF) of incident opioid use attributable to OA patients. RESULTS The 12-month prevalence of opioid use among OA patients was 23.7% [95% confidence intervals (CI) 23.3-24.2], which was two-fold higher compared to individuals without knee or hip OA: prevalence ratio: 2.1 [95% CI 2.1-2.1]. Similarly, OA patients were more likely to have an incident opioid dispensation, especially for strong opioids (incidence rate ratio: 2.6 [95% CI 2.5-2.7]). Population attributable tractions (PAF) of incident opioid use attributable to OA patients was 12%, 9% for weak and 17% for strong opioids. CONCLUSIONS Every fourth patient with knee or hip OA has opioids dispensed over a 1-year period, and 12% of incident opioid dispensations are attributable to OA and/or its related comorbidities. These results highlight that patients with knee and hip OA constitute a group of patients with an alarmingly high use of opioids.
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Affiliation(s)
- J B Thorlund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden
| | - D Prieto-Alhambra
- GREMPAL (Grup de Recerca en Epidemiologia de Les Malalties Prevalents de L'Aparell Locomotor), Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, And Musculoskeletal Sciences, University of Oxford, UK
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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27
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Abstract
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
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Affiliation(s)
- David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - Sita Bierma-Zeinstra
- Departments of General Practice and Orthopaedic Surgery, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
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Weber A, Mak SH, Berenbaum F, Sellam J, Zheng YP, Han Y, Wen C. Association between osteoarthritis and increased risk of dementia: A systemic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14355. [PMID: 30855434 PMCID: PMC6417538 DOI: 10.1097/md.0000000000014355] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the possible association between osteoarthritis (OA) and the risk of dementia. METHODS Cohort, case-control, and cross-sectional studies were obtained from wide literature search up to 20 April 2018 from following electronic databases: PubMed, Embase, Cochrane, using the MeSH terms: "osteoarthritis" AND "dementia". The literature search was then expanded to congress abstracts. After screening and selection of relevant studies by two investigators, data was extracted. Estimates were then calculated using a random-effect size model. Sensitivity-analysis was conducted for gender and age adjusted studies and pooled for studies with STROBE quality assessment score ≥75%. Publication bias was assessed by Funnel plot. Analyses were performed using Data Analysis and Statistical Software Version 14.2. RESULTS Nearly 1549 publication references were initially retrieved. Twenty-six publications were checked with full-text. Six observational studies with 388,252 individuals were included. OA was associated with a significantly increased risk for dementia (OR = 1.20; 95% confidence interval (CI), 1.03-1.39, I = 95.6%, P < .05). After pooling the studies with adjustment of age and gender, the risk increased (OR 1.36; 95% CI, 1.22-1.51, I = 75.6%, P < .0001). After pooling the study with a STROBE Quality score ≥75% the risk for dementia was slightly increased (OR 1.33; 95% CI, 1.17-1.5, I = 93.5%, p < 0.0001). CONCLUSIONS There is an association between osteoarthritis and the risk of dementia. This meta-analysis does not provide causality. Further prospective cohort studies are needed to clarify, if knee-, hip-, or hand-OA are independent risk factors for Alzheimer's disease and vascular dementia.
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Affiliation(s)
- Adrian Weber
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Shing hung Mak
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, PR China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yifan Han
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, PR China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017. Pain 2019; 160:1319-1326. [DOI: 10.1097/j.pain.0000000000001509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Lu Z, Li X, Chen R, Guo C. Kinesio taping improves pain and function in patients with knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg 2018; 59:27-35. [DOI: 10.1016/j.ijsu.2018.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
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Deveza LA, Hunter DJ, Van Spil WE. Too much opioid, too much harm. Osteoarthritis Cartilage 2018; 26:293-295. [PMID: 29277676 DOI: 10.1016/j.joca.2017.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 02/02/2023]
Affiliation(s)
- L A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - W E Van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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