chondroitin-sulfates and Weight-Loss

Knee osteoarthritis (OA) is a heterogeneous disease associated with substantial effects on quality of life, and its clinical management is difficult. Among the several available guidelines for the management of knee OA, those from OARSI and ESCEO were updated in 2019. Here, we examine the similarities and differences between these two guidelines and provide a narrative to help guide health-care providers through the complexities of non-surgical management of knee OA. OARSI and ESCEO both recommend education, structured exercise and weight loss as core treatments, topical NSAIDs as first-line treatments and oral NSAIDs and intra-articular injections for persistent pain. Low-dose, short-term acetaminophen, pharmaceutical grade glucosamine and chondroitin sulfate are recommended by ESCEO whereas OARSI strongly recommends against their use (including all glucosamine and chondroitin formulations). Despite this difference, the two guidelines are consistent in the majority of their recommendations and provide useful treatment recommendations for individuals with OA and health-care providers.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Consensus; Evidence-Based Medicine; Exercise Therapy; Glucosamine; Health Personnel; Humans; Injections, Intra-Articular; Osteoarthritis, Knee; Practice Guidelines as Topic; Quality of Life; Weight Loss

The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.

Topics: Acupuncture Therapy; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Braces; Chondroitin Sulfates; Curcuma; Exercise Therapy; Foot Orthoses; Glucosamine; Humans; Osteoarthritis, Knee; Overweight; Resistance Training; Ultrasonic Therapy; Weight Loss

Despite availability of international evidence-based guidelines for osteoarthritis (OA) management, agreement on the different treatment modalities is lacking.. A symposium of European and US OA experts was held within the framework of the Annual European Congress of Rheumatology to discuss and compare guidelines and recommendations for the treatment of knee OA and to reach a consensus for management, particularly for areas in which there is no clear consensus: non-pharmacological therapy; efficacy and safety of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs); intra-articular (i.a.) hyaluronates (HA); and the role of chondroitin sulfate (CS) and/or glucosamine sulfate (GS).. All guidelines reviewed agree that knee OA is a progressive disease of the joint whose management requires non-pharmacological and pharmacological approaches. Discrepancies between guidelines are few and mostly reflect heterogeneity of expert panels involved, geographical differences in the availability of pharmacotherapies, and heterogeneity of the studies included. Panels chosen for guideline development should include experts with real clinical experience in drug use and patient management. Implementation of agreed guidelines can be thwarted by drug availability and reimbursement plans, resulting in optimal OA treatment being jeopardized, HA and symptomatic slow-acting drugs for osteoarthritis (SySADOAs) being clear examples of drugs whose availability and prescription can greatly vary geographically. In addition, primary care providers, often responsible for OA management (at least in early disease), may not adhere to clinical care guidelines, particularly for non-pharmacological OA treatment.. Harmonization of the recommendations for knee OA treatment is challenging but feasible, as shown by the step-by-step therapeutic algorithm developed by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). More easily disseminated and implemented guidance for OA treatment in the primary care setting is key to improved management of OA.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Braces; Chondroitin Sulfates; Exercise Therapy; Foot Orthoses; Glucosamine; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis, Knee; Practice Guidelines as Topic; Viscosupplements; Weight Loss

Pain from knee osteoarthritis creates a significant burden for symptomatic patients, who are often forced to change their lifestyle because of their symptoms. Activity modification, therapy, weight loss, nonsteroidal anti-inflammatory drugs, shoe orthotics, bracing, and injections are the nonoperative options available. New technologies are also emerging in the treatment of knee osteoarthritis. Ultimately, these therapeutic modalities should reduce pain and increase the overall functioning of patients. These nonoperative modalities give the clinician several effective options before surgical management is considered.

Topics: Acetaminophen; Adrenal Cortex Hormones; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Dietary Supplements; Humans; Orthotic Devices; Osteoarthritis, Knee; Pain Management; Physical Therapy Modalities; Viscosupplements; Weight Loss

Topics: Acupuncture Therapy; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Knee; Arthroscopy; Braces; Capsaicin; Chondroitin Sulfates; Debridement; Electric Stimulation Therapy; Evidence-Based Medicine; Exercise Therapy; Glucosamine; Glycine max; Humans; Hyaluronic Acid; Massage; Osteoarthritis, Knee; Osteotomy; Patient Education as Topic; Persea; Phytotherapy; S-Adenosylmethionine; Shoes; Treatment Outcome; Weight Loss

Knee osteoarthritis (OA) is an extremely common cause of pain and disability. As the baby boomer cohort ages, general practitioners will see an increasing number of knee OA sufferers. Many effective nonoperative and operative therapies exist, but forming a coherent management plan is difficult. New therapeutic agents have gained popular interest, including chondroitin sulphate, glucosamine sulphate and viscosupplementation.. This paper outlines seven effective nonoperative therapies that every GP can initiate, discusses the roles of viscosupplementation, glucosamine and chondroitin sulphate and suggests when referral for surgical management is appropriate.. General practitioners are ideally suited to initiate nonoperative therapies, some of which are prophylactic as well as therapeutic. Nonoperative therapies include: education, weight loss, regular paracetamol, glucosamine-chondroitin sulphate, physical conditioning, quadriceps-hamstring strengthening, braces and variable, as required NSAIDs. Referral for surgical treatment is appropriate if the patient has residual pain and disability despite maximal nonoperative therapy.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Knee; Braces; Chondroitin Sulfates; Exercise Therapy; Glucosamine; Humans; Osteoarthritis, Knee; Patient Education as Topic; Weight Loss

Osteoarthritis of the knee is a common disease that causes significant disability. Most patients can be managed conservatively in the outpatient setting. A small minority require surgery. The cornerstones of treatment are weight loss, exercise and analgesia. Walking aids, medial patellar taping, acupuncture and transcutaneous electrical nerve stimulation are useful management adjuncts. Current evidence does not support routine prescription of glucosamine and chondroitin supplements. Early consultation with an orthopaedic surgeon should be made when conservative measures fail.

Topics: Acetaminophen; Acupuncture Therapy; Analgesia; Chondroitin; Chondroitin Sulfates; Dietary Supplements; Exercise; Female; Gait; Glucosamine; Humans; Injections, Intra-Articular; Knee Joint; Osteoarthritis, Knee; Outpatients; Transcutaneous Electric Nerve Stimulation; Weight Loss