2021 revised algorithm for the management of knee osteoarthritis\u2014the Chinese viewpoint

Zhiyi Zhang,Etienne Cavalier,Dan Xing,Yunpong Ding,Junhuan Guo,Yong Hou,Jean-Yves Reginster,Rong Mu,Nicola Veronese,Dongwei Fan,Huaihuan Zhang,Cibo Huang,Lin Jianhao,Olivier Bruyere,Yongping Cao,Mun Chan Zhang

doi:10.1007/s40520-021-01906-y

Abstract

AimThe European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide from 2014, but in 2019 an update was published. Based on this algorithm, a Working Group (WG), including ESCEO members and Chinese experts, wished to see how the new ESCEO algorithm was perceived by Chinese experts in knee OA and how it was integrated into their clinical practice.MethodsA WG was held between members of the international ESCEO task force and a group of Chinese experts.ResultsNon-pharmacological approach should be combined with pharmacological interventions. In step 1, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are the most important background drugs. Evidence, supported by high-quality research, is available only for crystalline glucosamine sulfate (pCGS) and chondroitin sulfate. Topical NSAIDs could be used as an additional option. In step 2, oral NSAIDs could be useful, but cardiovascular/renal/gastrointestinal profiles of the patients should be considered. Intra-articular hyaluronic acid and corticosteroids are alternative to oral NSAIDs, but the evidence is still limited. If steps 1 and 2 are not sufficient, weak opioids could be used. Overall, the conclusions of the ESCEO algorithm are accepted in China for products available in this country. The WG suggests the importance of economic studies, specifically made in China.ConclusionThis work provides evidence-based advice to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in China.

Highlights

Osteoarthritis (OA) is common, being characterized by typical signs with relevant consequences on functional decline, resulting in a relevant loss in quality of life [1, 2]
The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published some indications for the management of knee OA in 2014, creating a treatment algorithm that gives practical guidance for interventions and guiding physicians through steps based on the severity of knee OA [7]
The reasons for this decision regarding intra-articular drugs are based on their efficacy, higher risk of adverse events (AEs) when compared to placebo and only having short-term randomized placebo-controlled trials (RCTs) supporting the use of these drugs [9, 13]

Summary

CONSENSUS DOCUMENT

2021 revised algorithm for the management of knee osteoarthritis—the Chinese viewpoint. Zhiyi Zhang1 · Cibo Huang2 · Yongping Cao3 · Rong Mu3 · Mun Chan Zhang2 · Dan Xing4 · Dongwei Fan5 · Yunpong Ding2 · Junhuan Guo6 · Yong Hou7 · Lin Jianhao3 · Nicola Veronese8 · Jean‐Yves Reginster9,10 · Olivier Bruyere9,10 · Etienne Cavalier11 · Huaihuan Zhang

Introduction

Topical NSAIDs

Findings

Conclusions