The use of topical diclofenac in the pain management of osteoarthritis of the knee

Osteoarthritis (OA) is a common complaint that affects millions of people worldwide. As there is no cure for OA, drug treatment is the main form of management. This can be achieved through the use of analgesics and anti-inflammatory drugs such as the NSAID diclofenac sodium. The chronic use of diclofenac sodium can lead to adverse gastrointestinal problems. The use of a topical formulation of diclofenac sodium aims to reduce this problem. Evidence from four randomized controlled trails of the efficacy and safety of topical diclofenac sodium as a method of pain relief for the treatment of OA of the knee is presented and discussed. Findings imply that topical diclofenac sodium is an efficacious and safe method of pain control in patients with OA of the knee

Symptomatic efficacy and safety of diacerein in the treatment of osteoarthritis:a meta-analysis of randomized placebo-controlled trials

SummaryObjectiveTo estimate the efficacy and safety of diacerein as a pain-reducing agent in the treatment of osteoarthritis (OA), using meta-analysis of published randomized placebo-controlled trials (RCTs).MethodsSystematic searches of the bibliographic databases Medline, Embase, Cinahl, Chemical Abstracts, Cochrane and Web of Science for RCTs concerning diacerein treatment of OA. Inclusion criteria: explicit statement about randomization to either diacerein or placebo, and co-primary outcomes being reduction in pain and improvement in function. Efficacy effect size (ES) was estimated using Hedges's standardized mean difference. Safety was measured via the risk ratio (RR) of patients having at least one episode of diarrhoea, or withdrawal due to adverse events. Trials were combined by using random-effects meta-analysis. Consistency was evaluated via the I-squared index.ResultsSix trials (seven sub-studies; 1533 patients) contributed to the meta-analysis, revealing a large degree of inconsistency among the trials (I2=56%) in regard to pain reduction: the combined ES was −0.24 [95% confidence intervals (CI): −0.39 to −0.08, P=0.003], favouring diacerein. The statistically significant improvement in function (P=0.01) was based on a small amount of heterogeneity (I2=11%), but presented a questionable clinical effect size (ES=−0.14). Risk of publication bias could not be excluded, and trials with duration of more than 6 months did not favour diacerein. There was an increased risk of diarrhoea with diacerein (RR=3.51 [2.55–4.83], P<0.0001), and some withdrawal from therapy following adverse events (RR=1.58 [1.05–2.36], P=0.03).ConclusionsDiacerein may be an alternative therapy for OA for patients who cannot take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) because of adverse effects or lack of benefit. However, it is associated with increased risk of diarrhoea, and the symptomatic benefit after 6 months remains unknown

A qualitative study : the experience of general practitioners with older adult patients with osteoarthritis

Background: Osteoarthritis is a degenerative condition commonly effecting older adult patients in the community. There is a “demographic transition” leading to an ageing population. -- Objectives: To perform a qualitative study about how general practitioners (GPs) look at osteoarthritis, and its effects on patients’ lives as regards the biopsychosocial model. The aim is to analyse the GPs’ perspectives about the local available sources and any possible improvements. -- Method: Interpretative phenomenological analysis (IPA) was used as it allows the discovery of the details of each individual GP. Two GPs who have been practising for more than 5 years within the community volunteered through the Malta College of Family Doctors. Snowball sampling was used to recruit another two. Semi-structured interviews were then conducted, transcribed and analysed. -- Results: There was a common feeling that dealing with such a widespread disease is challenging within the community and there is a need for a specialised osteoarthritis clinic in the community to cater for all these patients’ needs via an interdisciplinary team. The need for a holistic approach was agreed amongst all the participants. There were four major themes: (i) osteoarthritis as a major health concern, (ii) the GP – a key role in the management of osteoarthritis in the community, (iii) challenges in community care and (iv) the future of primary care in the management of osteoarthritis. -- Conclusion: Osteoarthritis is a common, challenging condition which is treated by GPs; but being multi-faceted, input from other professionals is required.peer-reviewe

Knee osteoarthritis and Functional re-education. A comparison between dry and water activities

Osteoarthritis (OA) is a heterogeneous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related changes in the underlying bone at the joint margins (American College of Rheumatology). Among others, the joint most commonly affected are the knees. Although there is currently no cure for OA, several treatments focusing on relieving symptoms and improving function are available. Treatments can include a combination of patient education, weight control, use of medications, and physical therapy

Knee Viscosupplementation: Cost-Effectiveness Analysis between Stabilized Hyaluronic Acid in a Single Injection versus Five Injections of Standard Hyaluronic Acid

Given the wide difference in price per vial between various presentations of hyaluronic acid, this study seeks to compare the effectiveness and treatment cost of stabilized hyaluronic acid (NASHA) in a single injection with standard preparations of hyaluronic acid (HA) in five injections in osteoarthritis (OA) of the knee. Fifty-four patients with knee osteoarthritis (Kellgren–Lawrence Grade II and III) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score greater than 7, with a homogeneous distribution of age, sex, BMI, and duration of disease, were included in this study. Patients were randomized into two groups: Group I was treated with NASHA (Durolane®) and Group II with HA (Go-ON®). Patient’s evolution was followed up at the 1st, 2nd, 4th, 8th, 12th, and 26th week after treatment. A statistically significant improvement in WOMAC score was observed for patients treated with NASHA versus those who received HA at Week 26. In addition, the need for analgesia was significantly reduced at Week 26 in the NASHA-treated group. Finally, the economic analysis showed an increased cost of overall treatment with HA injections. Our data support the use of the NASHA class of products in the treatment of knee OA

Medium-term prognosis of an incident cohort of parkinsonian patients compared to controls

Funding This work was supported by Parkinson's UK (grant numbers G0502, G0914), BMA Doris Hillier Award, the BUPA Foundation, NHS Grampian Endowments, RS MacDonald Trust.Peer reviewedPublisher PD

Design and conduct of clinical trials in patients with osteoarthritis of the hand: recommendations from a task force of the Osteoarthritis Research Society International

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