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Review
. 2021 Dec 1;27(8):e533-e539.
doi: 10.1097/RHU.0000000000001507.

Pharmacological Management of Osteoarthritis With a Focus on Symptomatic Slow-Acting Drugs: Recommendations From Leading Russian Experts

Lila A M Alexander  1 , Denisov Ln, Zotkin Eg  1 , Dydykina Is  1 , Kochish Ay  2 , Rodionova Ss  3 , Trofimov Ea  4 , Yakupova Sp  5 , Yakupov Ez  6 , Gallelli L  7
Affiliations
Review

Pharmacological Management of Osteoarthritis With a Focus on Symptomatic Slow-Acting Drugs: Recommendations From Leading Russian Experts

Lila A M Alexander et al. J Clin Rheumatol. .

Abstract

Background: This article describes an updated stepwise algorithm for the pharmacological management of osteoarthritis (OA) to establish a treatment method for patients with OA.

Summary: In step 1, background maintenance therapy includes symptomatic slow-acting drugs for OA, especially prescription crystalline glucosamine sulfate product, for which the high-quality evidence base of efficacy is unequivocal, or prescription chondroitin sulfate. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol only as rescue analgesia is given on top of the background therapy. Step 2: For patients with persistent OA symptoms, the use of oral NSAIDs is mandatory for maintaining supportive therapy with symptomatic slow-acting drugs for OA. It is recommended to properly stratify patients and carefully select oral NSAID therapy to maximize the benefit-to-risk ratio. Intra-articular hyaluronic acid and intra-articular corticosteroids are recommended as well in step 2 of the algorithm, especially for patients who do not respond to the previous therapies. Step 3: Duloxetine is considered along with the previous procedures, especially in patients with pain from central sensitization. Step 4: Total joint replacement is recommended for patients with severe symptoms and poor quality of life.

Major conclusions: The current guidelines and literature review provide evidence-based recommendations supported by clinical experience on how to organize the treatment process in patients with knee OA applicable in the Russian clinical practice.

Future research directions: International evidence-based guidelines lack consensus on different treatments, including the use of prescription crystalline glucosamine sulfate, NSAIDs, and intra-articular hyaluronic acid. The content of this article needs a further discussion about the clinical evidence and harmonization of recommendations for knee OA management.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Centers for Disease Control and Prevention. What is osteoarthritis (OA)? Available at: https://www.cdc.gov/arthritis/basics/osteoarthritis.htm . Accessed February 7, 2018.
    1. Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: part I. Caspian J Intern Med . 2011;2:205–212.
    1. Herrero-Beaumont G, Ivorra JAR, del Carmen Trabado M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum . 2007;56:555–567.
    1. Folomeeva OM, Galushko EA, Erdes SF. Prevalence of rheumatic diseases in adult populations of Russian Federation and USA. Rheumatol Sci Pract . 2008;4:4–8.
    1. Balabanova RM, Erdes ShF. The incidence and prevalence of rheumatic diseases in Russia in 2012–2013. Rheumatol Sci Pract . 2015;2:120–124.

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