The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (Esceo) Algorithm for the Management of Knee Osteoarthritis Is Applicable to Russian Clinical Practice: A Consensus Statement of Leading Russian and Esceo Osteoarthritis Experts

Abstract

The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.

Nonprescription Drugs Recommended in Guidelines for Common Pain Conditions

“…Other analgesic combinations Some guidelines recommend that topical NSAIDs can be used alongside acetaminophen [26,[61][62][63][64][65][66][67]. In more severe osteoarthritis pain, it has been recommended that topical NSAIDs be used alongside oral NSAIDs [68].…”

Injectable Hyaluronic Acid Drugs for the Treatment of Knee Osteoarthritis in the Context of Evidence-Based Medicine

“…Именно такому контингенту больных рекомендуется назначение ГНК по данным Российско-Европейского консенсуса (рекомендации ESCEO) об алгоритмах лечения ОА коленного сустава от 2016 г. [71]. Вышеперечисленные факты заставляют констатировать назревшую острую необходимость в проведении дополнительных постмаркетинговых сравнительных исследований разрешенных к применению в Российской Федерации препаратов ГНК со стратификацией пациентов, которая будет учитывать особенности клинических симптомов заболевания, имеющиеся известные факторы риска прогрессирования ОА, а также степень морфологических изменений тканей сустава, верифицированную по данным МРТ и/или артроскопии.…”

Personalization of the use of non-steroidal anti-inflammatory drugs for musculoskeletal diseases. Resolution on the results of the Meeting of Experts of December 13, 2017

“…хондропротекторы) и парацетамола. Так, согласно широко известному алгоритму лечения ОА, разработанному группой ESCEO и одобренному российскими специалистами, НПВП при ОА следует применять «прерывисто или постоянно (продолжительными циклами)» [22,23]. Согласно данным метаанализа 74 РКИ (n = 58 556), НПВП при ОА достоверно эффективнее плацебо и парацетамола [24].…”