Osteoarthritis-associated Pain Research Articles

Factores que influyen en el uso continuado de la acupuntura y un resultado más positivo en los pacientes con artrosis de rodilla y cadera: estudio de seguimiento a los 3 años de un ensayo pragmático aleatorizado

ObjectiveConsidering the chronicity of osteoarthritis-associated pain, we aimed to evaluate long-term outcome differences between patients who received immediate or delayed acupuncture in addition to usual care, and to identify predictors for further acupuncture usage and a better long-term outcome. Materials and methodsThe Acupuncture in Routine Care study was an open-label, randomized pragmatic trial. As adjunct to usual care patients (>40 years, clinical and radiological diagnosis of primary osteoarthritis of the knee or hip, pain duration >6 months) received either immediate acupuncture in the first 3 months or delayed acupuncture in the subsequent 3 months. After 36 months 613 from 632 patients were available and asked to complete follow-up questionnaires. Primary outcome was the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). ResultsA total of 500 (82%) of the contacted patients completed their questionnaires. After 36 months the WOMAC Index did not differ significantly between both groups (immediate acupuncture 36.53±26.19 versus delayed acupuncture 38.24±25.54, P=.420). Further acupuncture treatment during the follow-up period was reported by 202 patients and predicted by previous successful acupuncture treatment at baseline (odds ratio=2.5, 95% confidence interval, 1.6–3.9). Less osteoarthritis symptoms (WOMAC index) after 36 months were predicted by being an acupuncture responder at 6 months (P<.001), having higher school education (P=.005), not wanting to use medications (P=.016) and using additional therapies (P<.001 to P=.025). DiscussionNo long-term outcome differences were found between patients who received immediate versus those that received delayed acupuncture treatment. Education level and additional therapies were identified as predictors for a better long-term outcome.

Feasibility and repeatability of thermal quantitative sensory testing in normal dogs and dogs with hind limb osteoarthritis-associated pain

The objectives of this study were to determine whether thermal quantitative sensory testing (QST) can be performed in client-owned dogs, is repeatable and whether QST differs between normal dogs and dogs with hind limb osteoarthritis (OA). This clinical, prospective, observational study used clinically normal dogs (n=23) and dogs with OA-associated hind limb pain (n=9). Thermal QST was performed in standing dogs using a high-powered light source delivered by a previously validated system. Dogs were tested on two occasions, 2weeks apart. Five tests were performed on each hind limb at each time point. Repeated measures analysis of variance was used to evaluate the effects of leg, time point and OA/normal status on thermal threshold latencies (TTL). Additionally, paired t tests were used to compare the TTL of left and right limbs within groups and between time points.Thermal thresholds were successfully measured in 32 client-owned dogs without prior training. TTL were significantly different between normal and OA dogs (P=0.012). There was no difference between limbs (P=0.744) or time periods (P=0.572), when analyzed by repeated measures analysis of variance, and no interactions between group and limb, visit and limb, or visit and group. In conclusion, thermal thresholds can be measured in client owned dogs with no prior training and are repeatable from week to week. Further data are required to determine if OA results in thermal hypoalgesia as measured at the distal hind limb and whether this is an indication of central sensitization.

Dose Reduction of Meloxicam in Dogs with Osteoarthritis‐Associated Pain and Impaired Mobility

Progressive nonsteroidal anti-inflammatory drug (NSAID) dose reduction appears logical; however, there is no evidence-based medicine indicating that efficacy is maintained as dose is reduced. To determine if NSAID dose can be reduced and pain relief and mobility can be maintained in dogs with osteoarthritis (OA). Client-owned dogs (n = 59) with OA-associated impaired mobility and pain. Prospective, randomized, blinded study. After 14 days wash-out, dogs were randomized to reducing dose (RDG) (n = 30) or maintenance dose (MDG) (n = 29). MDG received standard dose meloxicam. RDG received a reducing dose from D28 onward, reducing to 0% of maintenance for the final 2 weeks. Assessments were at D14, 28, 42, 56, 70, 84, 98 and 112 using subjective owner assessments, accelerometry (AM), and standing percent body weight distribution (%BW). A Kaplan-Meier survival curve described how dogs dropped out because of insufficient pain control. A Log-rank test compared the groups. More dogs in RDG (13) dropped out because of owner-evaluated insufficient pain control compared with MDG (5) (P = .029; odds ratio: 3.67; median dropout time: 84 days in each group). For the dogs that did not drop out (n = 41), there were no significant differences between groups in owner assessments (P > .2 for each), %BW placed on the index limb (P = .750), or accelerometer-measured activity (P = .14). Dose reduction is a less effective means of pain control compared with maintained dosing. However, NSAID dose reduction with maintained efficacy is possible, but success appears to be individual dog dependent.

Nonsteroidal anti-inflammatory drug gastropathy: new avenues for safety

Chronic oral or systemic nonselective nonsteroidal anti-inflammatory drug (NSAID) therapy, ubiquitously used by physicians to treat osteoarthritis-associated pain, is associated with a wide range of symptomatic adverse events, the most frequent and serious of which is gastropathy. Although cardiovascular and renal problems are a very real concern, they are significantly less frequent. These complications can be life-threatening in at-risk populations such as older adults, who are common users of long-term oral systemic NSAID therapy. Topical NSAID formulations deliver effective doses of analgesics directly to the affected joints, thereby limiting systemic exposure and potentially the risk of systemic adverse events, such as gastropathy and serious cardiovascular events. There are currently two topical NSAIDs approved by the US Food and Drug Administration for osteoarthritis-associated pain, as well as for the signs and symptoms of osteoarthritis. This review discusses the relative safety, and the gastrointestinal, cardiovascular, and renal risks of chronic oral or systemic NSAID therapy and topical NSAID formulations in patients with osteoarthritis.

Intra-articular Hyaluronic Acid Treatment for Golfer's Toe

ABSTRACTBACKGROUND: Osteoarthritis of the great toe can lead to a progressive decrease in range of motion (ROM) and pain at the first metatarsophalangeal (MTP) joint. This condition, observed in older golfers, results in reduced participation and enjoyment of this popular activity.OBJECTIVE: To assess the efficacy, safety, and patient satisfaction with a series of intra-articular injections of hyaluronic acid (HA) into the first MTP joint in older patients who reported osteoarthritis-associated pain, loss of MTP joint ROM, and disability that interfered with golf participation.METHODS: Forty-seven consecutive male golfers met the inclusion criteria and were given a weekly intraarticular HA injection for 8 weeks. Baseline measures of MTP joint ROM, pain at rest and immediately after tiptoe walking for 10 m, and global patient satisfaction (GPS) were compared with measures at 9 and 16 weeks and at presentation for a second injection series.RESULTS: Adverse events (only local injection site pain was noted) were <0.01%. At 9 weeks, significant improvement in pain at rest, pain after tiptoe walking, ROM, and GPS were observed. These changes were maintained for all measures at 16 weeks. At presentation for the second series, GPS was significantly higher than at baseline and at 16 weeks. Pain at rest, tiptoe walking pain, and ROM were significantly improved from baseline, but tiptoe-walking pain was significantly reduced at 16 weeks.CONCLUSION: Intra-articular HA injection significantly improved pain tolerance at rest and with activity. Patient acceptance of the treatment was high, with very few adverse events in golfers who had osteoarthritis of the first MTP joint.