Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult

Taylor, Nora

doi:10.1016/j.rdc.2018.03.009

Cited by 16 publications

(9 citation statements)

References 42 publications

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“…Approaches include nonsteroidal anti-inflammatory drugs, physical therapy, hyaluronic acid (HA), and corticosteroids, among others. [7][8][9] Intra-articular (IA) injections of corticosteroids have been utilized for years in the treatment of symptomatic knee OA with short-term effectiveness (1 week-3 months) 10 ; however, in a study by McAlindon et al, repeated injections over 2 years demonstrated small but potentially concerning long-term detrimental effects. 11 Similarly, despite reasonable clinical experience with various HA formulations, the AAOS has recently recommended against the use of HA in their AAOS CPGs since overall improvements were reported not to meet the minimum clinically important improvement thresholds.…”

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confidence: 99%

A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms

et al. 2019

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Placental-derived tissues are a known source of anti-inflammatory and immune modulating factors. Published pilot data on amniotic suspension allograft (ASA) for the treatment of osteoarthritis (OA) demonstrated safety and trends for improved pain and function. A multicenter randomized controlled trial was designed to evaluate the efficacy of symptom modulation with ASA compared with saline and hyaluronic acid (HA) in subjects with knee OA. A total of 200 subjects were randomized 1:1:1 to ASA, HA, or saline, with subjects blinded to their allocation. Changes from baseline of patient-reported outcomes (PROs)—EQ-5D-5L, Knee Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Tegner, and Single Assessment Numerical Evaluation (SANE)—were compared between groups. Patients reporting unacceptable pain at 3 months were considered treatment failures and withdrawn from the study. Statistical analysis was completed by comparing changes in PROs from baseline to 3 and 6 months for all groups. Comparison of demographics between treatment groups showed no significant differences between groups. Patients reporting unacceptable pain at 3 months in each group were ASA (13.2%), HA (68.8%), and saline (75%). Patients receiving ASA demonstrated significantly greater improvements from baseline for overall pain (VAS), KOOS pain, and KOOS-activities of daily living scores compared with those in the HA group (3 months) and both groups (6 months). ASA patients had significantly greater improvements in KOOS symptom scores compared with HA and saline at 3 and 6 months, respectively. OMERACT-OARSI responder rates for ASA, HA, and saline groups were 69.1, 39.1, and 42.6%, respectively (p = 0.0007). Subjects receiving ASA treatment showed greater improvements in PROs and fewer patients reported unacceptable pain compared with HA and saline. The evidence presented in this Level I Randomized Controlled Trial suggests that ASA injection is an effective treatment for the nonoperative management of symptomatic knee OA.

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confidence: 99%

A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms

et al. 2019

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“…KOA affects over 70 million people in Europe and the direct medical costs exceed 2 billion Euros, which represents a social, economic burden and KOA was the 11th leading cause of disability according to the World Health Organization (WHO) global burden of disease study 2010 [1, 5]. Patients with KOA are often treated surgically and managed conservatively [6]; surgical treatment includes total knee arthroplasty (TKA), arthroscopic surgery and so on and is well-known to substantially reduce KOA-related pain and improve function [7, 8]. However, some patients are not actually willing to undergo TKA, due in large part to lack of confidence in beneficial surgery outcomes and postoperative complications such as chronic pain after TKA, which can affect all dimensions of health-related quality of life [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomized, double-blind, parallel positive controlled, multi-center clinical trial

Yao

Tian

et al. 2019

Trials

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Background Knee osteoarthritis (KOA) is a common chronic musculoskeletal disorder that seriously affects quality of life. Patients with KOA frequently develop one or more of the following typical symptoms: joint pain, stiffness, joint friction noise and impaired functionality. Traditional Chinese medicine (TCM) has been shown to have a superior effect and a particular advantage in the treatment of KOA; among TCM, the Tong-luo Qu-tong plaster is the convenient and most commonly used method in China to improve symptoms including pain, stiffness and limited mobility in patients with KOA, as it causes few adverse effects. But there is a lack of high-quality clinical evidences to support the therapeutic effect that Chinese adhesive plaster can have in relieving pain and stiffness. The purpose of this study will be to evaluate the efficacy and safety of Tong-luo Qu-tong plaster in patients with KOA. Methods/design This study will be a randomized, double-blind, parallel positive controlled, multi-center clinical trial, a non-inferiority trial design was adopted. A total of 2000 participants older than 40 years, with KOA, will be randomly allocated into an experimental group ( n = 1500) and a control group ( n = 500). All participants will receive a conventional conservative treatment lasting for 14 days as two courses, once daily. Tong-luo Qu-tong plaster will be administered externally to participants in the experimental group, while the control group will receive a Qi-zheng Xiao-tong plaster. The outcome of the total Western Ontario and McMaster Universities Arthritis Index scores, TCM syndrome quantitative score and visual analog scale scores will be measured during the assessment visits (baseline and 1-week and 2-week follow up). In addition, adverse events related to clinical symptoms and signs and results of laboratory tests will be documented during the clinical trials. Discussion This study will provide reliable evidence of the effectiveness and safety of Tong-luo Qutong plaster in patients with KOA. If the results are favorable, it is expected that the patients with KOA will benefit from this study, many patients may have a good alternative treatment for KOA. Trial registration ClinicalTrials.gov, ID: NCT03309501 . Registered on 8 November 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3481-6) contains supplementary material, which is available to authorized users.

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“…KOA affects over 70 million people in Europe and the direct medical costs exceed 2 billion Euros, which represented a social, economic burden and was the 11th leading cause of disability according to World Health Organization (WHO) global burden of disease study 2010 [1,5]. Surgical treatment and conservative management are often used for patients with KOA [6], surgical treatment including total knee replacement (TKA), arthroscopic surgery and so on for KOA is well-known to substantially improve KOA related pain and function [7,8]. However, part of TKA candidates are not actually willing to undergo the surgery, due in large part to lack of confidence in beneficial surgery outcomes and postoperative complications such as chronic pain after TKA which can affect all dimensions of health related quality of life [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…However, the application of NSAIDs is reported to lead to some incidences of adverse effects, including gastrointestinal tract impairment and the possible promotion of articular deterioration [6,11]. Because of lack of effectiveness, the of recommendation against chondroprotective agents such as glucosamine and chondroitin have existed in recent decades [12].…”

Section: Introductionmentioning

confidence: 99%

Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomised, double-blind, parallel positive control, multi-center clinical trial

Yao

Tian

et al. 2019

Preprint

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Background: Knee osteoarthritis (KOA) is a common chronic musculoskeletal disorder that seriously affect quality of life. Patients with KOA frequently develop one or more of the typically following symptoms: joint pain, stiffness, joint friction noise, impaired functionality. Traditional Chinese medicines (TCM) have showed a superior effect and peculiar advantage on the treatment of KOA, among TCMs, the Tong-luo Qu-tong plaster is the convenient and most commonly used method in China to improve symptoms including pain, stiffness and limited mobility in patients with KOA, as it causes few adverse effects. But there is a lack of high quality of clinical evidences to support the therapeutic effect that Chinese adhesive plaster can relieve pain and stiffness. The purpose of this study will be to evaluate the efficacy and safety of Tong-luo Qu-tong plaster in patients with KOA. Methods/Design: This study will be a randomised, double-blind, parallel positive control, multi-center clinical trial, a non-inferiority trial design was adopted. A total of 2000 participants older than 40 years with KOA, will be randomly allocated into a experimental group (n=1500) and a control group (n=500). All participants will receive a conventional conservative treatment lasted for 14 days as two courses, daily 1 time. Tong-luo Qu-tong plaster will be administered externally to participants in the experimental group, while the control group will receive a Qi-zheng Xiao-tong plaster. The outcome of the total Western Ontario and McMaster Universities Arthritis Index scores, TCM syndrome quantitative score, visual analog scale scores will be measured during the assessment visits (baseline and 1-, 2-week follow-up). In addition, adverse events concerning clinical symptoms and signs as well as laboratory tests will be documented during clinical trials. Discussion: This study will be a randomized, double-blind, parallel positive control trial to further evaluate the effectiveness and safety of Tong-luo Qu-tong plaster for patients with KOA in nine medical centers compared with control group, it is expected that the patients with KOA will benefit from this study.

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Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult

Cited by 16 publications

References 42 publications

A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms

A Randomized Controlled Single-Blind Study Demonstrating Superiority of Amniotic Suspension Allograft Injection Over Hyaluronic Acid and Saline Control for Modification of Knee Osteoarthritis Symptoms

Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomized, double-blind, parallel positive controlled, multi-center clinical trial

Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomised, double-blind, parallel positive control, multi-center clinical trial

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