Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis

Jevsevar, David S.; Shores, Peter; Mullen, Kyle; Schulte, Danielle M.; Brown, Gregory A.; Cummins, Deborah

doi:10.5435/jaaos-d-17-00318

Cited by 57 publications

(69 citation statements)

References 65 publications

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“…We would like to highlight that despite the fact that in the last 15 years many randomized controlled trials and at least 40 meta-analyzes have been published on the effectiveness and safety of IAHA for the treatment of KOA, there is still much controversy and uncertainty on this topic. [ 31 ] If we consider only some of the meta-analyzes published in the past 5 years, we will see that some of them recommend IAHA as a very effective and safe treatment, [ 24 , 32 – 34 ] while others contraindicate this intervention, [ 31 , 35 , 36 ] both due to its low effectiveness, as well as the lack of safety. We can explain these conflicting results for several reasons: the low quality of the meta-analyzes, [ 31 ] individual differences in the formulation of the IAHA, [ 30 ] specific clinical characteristics of the patients [ 37 ] and even the presence of conflicts of interest (declared or not) by the authors of the studies and/or financing of studies by the industry.…”

Section: Discussionmentioning

confidence: 99%

Viscossuplementation for the treatment of osteoarthritis of the knee

Pereira

et al. 2020

Medicine

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Background: Knee osteoarthritis (KOA) is a common chronic disease with worldwide prevalence of 10% to 79%, with costs ranging from $560 to $635 billion for year in United States of America. The main guidelines recommend interventions with undesirable adverse events (AE) or highly dependent on the patient's persistence. Thus, intra-articular (IA) therapies appear to be attractive in patients with KOA, as well as a valid therapy by maximizing effects locally in the joint and limiting systemic AE. Presently, the main available IA therapies are corticosteroids and hyaluronic acid. As several meta-analyses about the efficacy of intra-articular hyaluronic acid (IAHA) for treatment of KOA with discordant results were published, we decided to conduct an umbrella review to summarize this efficacy Methods: We will search MEDLINE/PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) from inception to February 2020 for systematic reviews with meta-analyses of randomized clinical trials that investigate IAHA for therapy of KOA. Grey literature will be searched in Opengray platform, Research Gate, and Google Scholar. The reference lists of eligible studies will be screened. The search will be performed without language restriction. We will include any type of IAHA as experimental intervention and different types of oral or intra-articular placebo or medications as controls. The primary outcome will be measures of efficacy as the Western Ontario and McMaster Universities Osteoarthritis Index. A synthesis of the evidence will be conducted and data will be presented in tables. Two reviewers will independently appraise the quality of included meta-analyses using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and will classify the included systematic reviews into high, moderate, low, or critically low levels of confidence. Results: The results of this study will be published in a peer-reviewed journal. Ethics and dissemination: No ethical approval is required since this study data is based on published literature. Protocol registration number: PROSPERO CRD42019120269 ( https://www.crd.york.ac.uk/PROSPERO/#joinuppage ).

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Section: Discussionmentioning

confidence: 99%

Viscossuplementation for the treatment of osteoarthritis of the knee

Pereira

et al. 2020

Medicine

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“…pharmacological management of knee OA often includes education and self-management, weight loss and strengthening, and biomechanical interventions such as knee braces [11][12][13]. Anti-inflammatories are recommended for patients with symptomatic OA of the knee to address pain; however, prolonged use of NSAIDS increases risk of gastrointestinal (GI), cardiovascular, and renal complications [14,15].…”

Section: Key Summary Pointsmentioning

confidence: 99%

Cost-Effectiveness of Treating Early to Moderate Stage Knee Osteoarthritis with Intra-articular Hyaluronic Acid Compared to Conservative Interventions

Rosen

Niazi

Dysart³

2019

Adv Ther

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Introduction: Evidence has demonstrated greater benefit of intra-articular hyaluronic acid (IA-HA) within earlier stages of knee osteoarthritis (OA) rather than waiting for patients to have progressed to later stages of disease progression. High molecular weight (HMW) HA has also been shown to be more effective than low molecular weight (LMW) HA products in mild to moderate knee OA, providing an important distinction to make within the class of IA-HA therapies. The purpose of this study is to evaluate the cost-effectiveness of treating patients with knee OA with HMW HA Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.10048502.

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“…Two other studies of the efficacy of Hyalgan ® have shown that the effects of intra-articular injection are similar to Naproxen treatment, taken continuously over a 26week period of time (17). According to the Journal of the American Academy of Orthopaedic Surgeons, Naproxen is the most effective NSAID used in the treatment of KOA with a powerful analgesic effect, but its long-term use develops characteristic NSAID's side effects (26). KOA is a surgical endwear disease.…”

Section: Osteoarthritis Treatment and Recoverymentioning

confidence: 99%

Efficacy of intra-articular hyaluronic acid injections in the rehabilitation programme of Knee Osteoarthritis

Onu

Matei

Galaction

2019

BALNEO

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Knee osteoarthritis (KOA) is a disease of wear and tear, leading to disability and ultimate surgical treatment. KOA has multiple etiologies and is considered a disorder of physiological processes that is manifested by progressive lesions of articular cartilage caused by chondrolysis, synovial membrane inflammation and subchondral osteophytes production. Modalities that limit the progression of the KOA and rehabilitation are a constant interest for clinicians and medical researchers. Various physical therapies and pharmacological strategies are currently used for pain management, with no clear benefit in terms of inhibiting disease progression. In this context, the use of exogenous hyaluronic acid (HA) (that is a vital component of the synovial fluid and involved in lubricating all synovial joints) has been explored as viable alternative to alleviate knee pain and temporarily restore knee function. In the following, we will review the use of HA injections associated with the physiotherapeutic recovery plan in the treatment of KOA. The therapeutic effects of the HA is still a matter of debate in the field, with no consensus being reached so far and thus, difficult to evaluate. However, much research has to be done to understand the therapeutic efficacy of HA alone or in combination with physical therapies and the role that other factors may play in unraveling its beneficial effects on the KOA. Key words: knee, osteoarthritis, hyaluronic acid, physiotherapy, rehabilitation,

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Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis

Cited by 57 publications

References 65 publications

Viscossuplementation for the treatment of osteoarthritis of the knee

Viscossuplementation for the treatment of osteoarthritis of the knee

Cost-Effectiveness of Treating Early to Moderate Stage Knee Osteoarthritis with Intra-articular Hyaluronic Acid Compared to Conservative Interventions

Efficacy of intra-articular hyaluronic acid injections in the rehabilitation programme of Knee Osteoarthritis

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