NICE (National Institute for Health and Care Excellence) recommendations in the treatment of osteoarthritis Review article
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Published:
Mar 31, 2020
Keywords:
topical and oral analgesics, NSAID, NICE, osteoarthrosis
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Abstract
Osteoarthritis is the most common musculoskeletal disorder. It affects most often the spine, knee, hip, shoulder and hand joints. Treatment of diseases is symptomatic and generally focuses on reducing pain and other symptoms. The core treatments are adequate education and access to appropriate information, activity and exercise and interventions to achieve weight loss if the person is overweight or obese. In addition, paracetamol and topical non-steroidal anti-inflammatory drugs (NSAIDs) should be used to reduce pain. Among local NSAIDs, diclofenac is the most effective and bioavailable. The use of oral NSAIDs or cyclooxygenase 2 (COX-2) inhibitors and opioids, should be considered when paracetamol and topical NSAIDs are ineffective in reducing pain.
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Liszka, H. (2020). NICE (National Institute for Health and Care Excellence) recommendations in the treatment of osteoarthritis. Medycyna Faktow (J EBM), 13(1(46), 121-126. https://doi.org/10.24292/01.MF.0120.14
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References
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17. Sioufi A., Pommier F., Boschet F. et al.: Percutaneous absorption of diclofenac in healthy volunteers after single and repeated topical application of diclofenac emulgel. Biopharm. Drug Dispos. 1994; 15(6): 441-449.
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21. Rannou F., Pelletier J.P., Martel-Pelletier J.: Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin. Arthritis Rheum. 2016; 45(4 supl.): S18-21.
22. Kołodziejska J., Kołodziejczyk M.: Diclofenac in the treatment of pain in patients with rheumatic diseases. Reumatologia 2018; 56(3): 174-183.
23. Derry S., Wiffen P.J., Kalso E.A.: Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database Syst. Rev. 2017; CD008609.
24. Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis, 2009 [online: https: //www.racgp.org.au/download/documents/Guidelines/Musculoskeletal/racgp_oa_guideline.pdf].
25. Zhang W., Moskowitz R.W., Nuki G. et al.: OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007; 15: 981-1000.
26. Jordan K.M., Arden N.K., Doherty M.: EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann. Rheum. Dis. 2003; 62(12): 1145-1155.
27. National Institute for Health and Care Excellence Recommendations on Osteoarthritis: care and management, 2014 [online: https://www.nice.org.uk/guidance/cg177/chapter/1-recommendations].
28. Zacher J., Altman R., Bellamy N. et al.: Topical diclofenac and its role in pain and inflammation: an evidence-based review. Curr. Med. Res. Opin. 2008; 24(4): 925-950.
2. WHO (2014), “Chronic Rheumatic Conditions”, Fact Sheet, WHO, Geneva [online: www.who.int/chp/topics/rheumatic/en/].
3. Migliore A., Granata M.: Intra-articular use of hyaluronic acid in the treatment of osteoarthritis Clin. Interv. Aging 2008; 3(2): 365-369.
4. Gądek A., Miśkowiec K., Wordliczek J., Liszka H.: Skuteczność działania i bezpieczeństwo preparatu Suplasyn w leczeniu choroby zwyrodnieniowej stawu kolanowego. Przegl. Lek. 2011; 68: 307-310.
5. Szczeklik A.: Choroby wewnętrzne. Medycyna Praktyczna, Kraków 2005.
6. Zhang W., Nuki G., Moskowitz R.W. et al.: OARSI recommendations for the management of hip and knee osteoarthritis. Osteoarthritis and Cartilage 2010.
7. Osteoarthritis: care and management. Clinical guideline. Published: 12 February 2014 [online: www.nice.org.uk/guidance/cg177].
8. Machado G.C., Maher C.G., Ferreira P.H. et al.: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta- analysis of randomised placebo controlled trials. BMJ 2015; 350: h1225.
9. Schnitzer T., Morton C., Coker S.: Topical capsaicin therapy for osteoarthritis pain: achieving a maintenance regimen. Semin. Arthritis Rheum. 1994; 23: 34-40.
10. Kloppenburg M., Kroon F.P., Blanco F.J. et al.: 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann. Rheum. Dis. 2019; 78(1): 16-24.
11. Talke M.: Treatment of heberden and bouchard types of finger osteoarthritis. Comparison between local etofenamate and oral indomethacin. Therapiewoche 1985; 35: 3948-3954.
12. Zacher J., Burger K.J., Farber L. et al.: Topical diclofenac versus oral ibuprofen: A double blind, randomized clinical trial to demonstrate efficacy and tolerability in patients with activated osteoarthritis of the finger joints (Heberden and/or Bouchard arthritis). Aktuelle Rheumatologie 2001; 26: 7-14.
13. Altman R.D., Dreiser R.L., Fisher C.L. et al.: Diclofenac sodium gel in patients with primary hand osteoarthritis: a randomized, double-blind, placebo- controlled trial. J. Rheumatol. 2009; 36: 1991-1999.
14. Rao P., Knauss E.E.: Evolution of nonsteroidal anti-inflammatory drugs (NSAIDs): cyclooxygenase (COX) inhibition and beyond. J. Pharm. Pharm. Sci. 2008; 11: 81s-110s.
15. Derry S., Moore R.A., Gaskell H. et al.: Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst. Rev. 2015; 11(6): CD007402.
16. Gondolph-Zink B., Gronwald U.: Wirkstoffkonzentrationen in artikulären und periartikulären Geweben des Kniegelenkes nach kutaner Anwendung von Diclofenac-Diethylammonium Emulgel. Akt. Rheumatol. 1996; 21: 298-304.
17. Sioufi A., Pommier F., Boschet F. et al.: Percutaneous absorption of diclofenac in healthy volunteers after single and repeated topical application of diclofenac emulgel. Biopharm. Drug Dispos. 1994; 15(6): 441-449.
18. Riess W., Schmid K., Botta L. et al.: The percutaneous absorption of diclofenac. Arzneimittelforschung 1986; 36(7): 1092-1096.
19. Brune K.: Persistence of NSAIDs at effect sites and rapid disappearance from side-effect compartments contributes to tolerability. Curr. Med. Res. Opin. 2007; 23(12): 2985-2995.
20. Davies N.M., Anderson K.E.: Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls. Clin. Pharmacokinet. 1997; 33(3): 184-213.
21. Rannou F., Pelletier J.P., Martel-Pelletier J.: Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin. Arthritis Rheum. 2016; 45(4 supl.): S18-21.
22. Kołodziejska J., Kołodziejczyk M.: Diclofenac in the treatment of pain in patients with rheumatic diseases. Reumatologia 2018; 56(3): 174-183.
23. Derry S., Wiffen P.J., Kalso E.A.: Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database Syst. Rev. 2017; CD008609.
24. Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis, 2009 [online: https: //www.racgp.org.au/download/documents/Guidelines/Musculoskeletal/racgp_oa_guideline.pdf].
25. Zhang W., Moskowitz R.W., Nuki G. et al.: OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007; 15: 981-1000.
26. Jordan K.M., Arden N.K., Doherty M.: EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann. Rheum. Dis. 2003; 62(12): 1145-1155.
27. National Institute for Health and Care Excellence Recommendations on Osteoarthritis: care and management, 2014 [online: https://www.nice.org.uk/guidance/cg177/chapter/1-recommendations].
28. Zacher J., Altman R., Bellamy N. et al.: Topical diclofenac and its role in pain and inflammation: an evidence-based review. Curr. Med. Res. Opin. 2008; 24(4): 925-950.