What factors affect the effectiveness of long - term analgesic therapy for osteoarthritis? Data analysis of the multi - center 3-month PARACELSUS study


Cite item

Full Text

Abstract

There are factors that can affect the effectiveness of treatment of osteoarthritis (OA). Aim to identify factors affecting the effectiveness of long - term analgesic therapy in OA. Materials and methods. The study included 6448 patients (70.9% female and 29.1% male), middle age 57.8±10.2 years, with severe pain [≥40 mm on the visual analog scale]. All patients received the preparation of avocado - soybean unsaponifiables (ASU) 300 mg/day. For pain relief at the beginning and during the study, the drug Ketoprofen lysine salt (KLS) 320 mg/day was used. The efficiency criterion was pain reduction ≥50% and satisfaction with treatment ≥4 on a 5-point scale. The influence of a number of factors on the result of treatment was evaluated. Results. For 3 months of treatment, the pain decreased from 63.7±12.0 to 14.2±11.7 mm VAS. The result was evaluated as "good" or "excellent" 81.7% of patients. Adverse reactions were rare. In total, a good response to therapy was noted in 87.4% of patients. Gender, body mass index ≥30 kg/m2, type 2 diabetes mellitus, poor effect of non - steroidal anti - inflammatory drugs (NSAIDs) and Symptomatic Slow-Acting Drugs in Osteoarthritis (SYSADOA) in history did not affect the result. The effect was lower in persons >65 years [odds ratio (OR) 0.418; 95% confidence interval (CI) 0.342-0.509, p<0.001], with radiological stage >2 by Kellgren-Lawrence (OR 0.556; 95% CI 0.298-0.738, p<0.001), with pain at rest (OR 0.690; 95% CI 0.596-0.800, p<0.001), synovitis (OR 0.778; 95% CI 0.673-0.900, p=0.001), pain in the enthesis region (OR 0.846; 95% CI 0.616-0.957, p=0.032), and also in the presence of central sensitization descriptors (CS; OR 0.530; 95% CI 0.458-0.613, p<0.001). Conclusion. The combination of ASU and NSAID (KLS) allows for successful control of pain in OA. Factors such as age >65 years, stage OA of K/L >2, pain at rest, synovitis, pain in the region of enthesis and the presence of CS descriptors associated with the worst treatment outcome.

About the authors

A E Karateev

V.A. Nasonova Scientific and Research Institute of Rheumatology

Email: aekarat@yandex.ru
д.м.н., зав. лаб. патофизиологии боли и полиморфизма скелетно-мышечных заболеваний, в.н.с. ФГБНУ «НИИР им. В.А. Насоновой»; ORCID: 0000-0002-1391-0711 Moscow, Russia

A M Lila

V.A. Nasonova Scientific and Research Institute of Rheumatology

д.м.н., проф., директор ФГБНУ «НИИР им. В.А. Насоновой»; ORCID: 0000-0002-6068-3080 Moscow, Russia

E Yu Pogozheva

V.A. Nasonova Scientific and Research Institute of Rheumatology

к.м.н., н.с. ФГБНУ «НИИР им. В.А. Насоновой»; ORCID: 0000-0001-5103-5447 Moscow, Russia

V N Amirdzhanova

V.A. Nasonova Scientific and Research Institute of Rheumatology

д.м.н., в.н.с. ФГБНУ «НИИР им. В.А. Насоновой»; ORCID: 0000-0001-5382-6357 Moscow, Russia

E S Filatova

V.A. Nasonova Scientific and Research Institute of Rheumatology

к.м.н., н.с. ФГБНУ «НИИР им. В.А. Насоновой»; ORCID 0000-0002-2475-8620 Moscow, Russia

References

  1. Российские клинические рекомендации. Ревматология. Под ред. Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2017:446 с. ISBN 978-5-9704-4261-6
  2. Murray C.J, Barber R.M, Foreman K.J, et al. Global, regional, and national disability - adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015 Nov 28;386(10009):2145-91. doi: 10.1016/S0140-6736(15)61340-X Epub 2015 Aug 28
  3. Балабанова Р.М., Эрдес Ш.Ф. Распространенность ревматических заболеваний в России в 2012-2013 гг. Научно - практическая ревматология. 2015;53(2):120-4.
  4. Фоломеева O.M., Галушко Е.А., Эрдес Ш.Ф. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научно - практическая ревматология. 2008;46(4):4-13.
  5. "Arthritis-Related Statistics: Prevalence of Arthritis in the United States". Centers for Disease Control and Prevention, US Department of Health and Human Services. 9 November 2016. На сайте: https://www.cdc.gov/ arthritis/data_statistics/arthritis-related-stats.htm
  6. Pfuntner A, Wier L.M, Stocks C. Most Frequent Conditions in U.S. Hospitals, 2011: Statistical Brief #162. Source Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006-2013 Sep.
  7. Mc Alindon T.E, Bannuru R.R, Sullivan M.C, et al. OARSI guidelines for the non - surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014 Mar;22(3):363-88. doi: 10.1016/j.joca.2014.01.003 Epub 2014 Jan 24
  8. Bruyère O, Cooper C, Pelletier J.P, et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence - based medicine to the real - life setting. Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S3-11. doi: 10.1016/j.semarthrit.20 15.11.010 Epub 2015 Dec 2
  9. Robinson W.H, Lepus C.M, Wang Q, et al. Low - grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016 Oct;12(10):580-92. doi: 10.1038/nrrheum.2016.136 Epub 2016 Aug 19
  10. Mathiessen A, Conaghan P.G. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017 Feb 2;19(1):18. doi: 10.1186/s13075-017-1229-9
  11. Towheed T, Maxwell L, Anastassiades T, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005 Apr 18;(2): CD002946.
  12. Reichenbach S, Sterchi R, Scherer M, et al. Meta - analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007;146(8):580-90.
  13. Fidelix T, Soares B, Trevisani V. Diacerein for osteoarthritis. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005117.
  14. Clegg D.O, Reda D.J, Harris C.L, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.
  15. Moore R, Moore O, Derry S, et al. Responder analysis for pain relief and numbers needed to treat in a meta - analysis of etoricoxib osteoarthritis trials: bridging a gap between clinical trials and clinical practice. Ann Rheum Dis. 2010;69:374-9.
  16. Sarzi-Puttini P, Atzeni F, Lanata L, et al. Pain and ketoprofen: what is its role in clinical practice? Reumatismo. 2010;62(3):172-88.
  17. Le Loet X. Safety of ketoprofen in the elderly: a prospective study on 20,000 patients. Scand J Rheumatol Suppl. 1989;83:21-7.
  18. Sarzi-Puttini P, Atzeni F, Lanata L, Bagnasco M. Efficacy of ketoprofen vs. ibuprofen and diclofenac: a systematic review of the literature and meta - analysis. Clin Exp Rheumatol. 2013 Sep-Oct;31(5):731-8. Epub 2013 May 17
  19. Каратеев А.Е., Журавлева М.В., Алексеев В.В. и др. Эффективность комбинации лекарственных форм кетопрофена лизиновой соли (Артрозилен®) у пациентов с мышечно - скелетной болью в клинической практике: Исследование КУЛОН (Кетопрофен: удовлетворенность лечением и оценка нежелательных явлений). Клиническая фармакология и терапия. 2013;22(4):22-30.
  20. Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014 May 22;(5):CD002947. doi: 10.1002/1 4651858.CD002947.pub2
  21. Christensen R, Bartels E, Astrup A, Bliddal H. Symptomatic efficacy of avocado - soybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta - analysis of randomized controlled trials. Osteoarthritis Cartilage. 2008;16(4):399-408.
  22. Maheu E, Cadet C, Marty M, et al. Randomised, controlled trial of avocado - soybean unsaponifiable (Piascledine) effect on structure modification in hip osteoarthritis: the ERADIAS study. Ann Rheum Dis. 2014 Feb;73(2):376-84. Epub 2013 Jan 23. doi: 10.1136/annrheumdis-2012-202485
  23. Głuszko P, Stasiek M. Symptom - modifying effects of oral avocado/soybean unsaponifiables in routine treatment of knee osteoarthritis in Poland. An open, prospective observational study of patients adherent to a 6-month treatment. Reumatologia. 2016;54(5):217-26. Epub 2016 Nov 28.
  24. Courties A, Gualillo O, Berenbaum F, Sellam J. Metabolic stress - induced joint inflammation and osteoarthritis. Osteoarthritis Cartilage. 2015 Nov;23(11):1955-65. doi: 10.1016/j.joca.2015.05.016 Epub 2015 May 30.
  25. Belluzzi E, El Hadi H, Granzotto M, et al. Systemic and Local Adipose Tissue in Knee Osteoarthritis. J Cell Physiol. 2017 Aug;232(8):1971-8. doi: 10.1002/jcp.25716 Epub 2017 Mar 3.
  26. Nawai A, Leveille S.G, Shmerling R.H, et al. Pain severity and pharmacologic pain management among community - living older adults: the MOBILIZE Boston study. Aging Clin Exp Res. 2017 Feb 21. doi: 10.1007/s40520-016-0700-9 [Epub ahead of print.]
  27. Larsson C, Hansson E.E, Sundquist K, Jakobsson U. Chronic pain in older adults: prevalence, incidence, and risk factors. Scand J Rheumatol. 2016 Nov 25;1-9. doi: 10.1080/03009742.2016.1218543 [Epub ahead of print.]
  28. Bedson J, Croft P.R. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008 Sep 2;9:116. doi: 10.1186/1471-2474-9-116
  29. Wang Y, Teichtahl A.J, Abram F, et al. Knee pain as a predictor of structural progression over 4 years: data from the Osteoarthritis Initiative, a prospective cohort study. Arthritis Res Ther. 2018 Nov 6;20(1):250. doi: 10.1186/s13075-018-1751-4
  30. Chan W.P, Huang G.S, Hsu S.M, et al. Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain. Skeletal Radiol. 2008 Oct;37(10):917-22. doi: 10.1007/s00256-008-0530-8 Epub 2008 Jul 2.
  31. Murphy S.L, Lyden A.K, Phillips K, et al. Association between pain, radiographic severity, and centrally - mediated symptoms in women with knee osteoarthritis. Arthritis Care Res (Hoboken). 2011 Nov;63(11):1543-9. doi: 10.1002/acr.20583
  32. Raman S, Fitz-Gerald U, Murphy J.M. Interplay of Inflammatory Mediators with Epigenetics and Cartilage Modifications in Osteoarthritis. Front Bioeng Biotechnol. 2018 Mar 14;6:22. doi: 10.3389/fbioe.2018.00022. eCollection 2018
  33. Lieberthal J, Sambamurthy N, Scanzello C.R. Inflammation in joint injury and post - traumatic osteoarthritis. Osteoarthritis Cartilage. 2015 Nov;23(11):1825-34. doi: 10.1016/j.joca.2015.08.015
  34. Dell'Isola A, Allan R, Smith S.L, et al. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016 Oct 12;17(1):425.
  35. Dell'Isola A, Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative. PLoS One. 2018 Jan 12;13(1):e0191045. doi: 10.1371/journal.pone.01910 45.eCollection 2018
  36. Snelling S.J, Bas S, Puskas G.J, et al. Presence of IL-17 in synovial fluid identifies a potential inflammatory osteoarthritic phenotype. PLoS One. 2017 Apr 11;12(4):e0175109. doi: 10.1371/journal.pone.0175109.eCollect ion 2017
  37. Каратеев А.Е., Лила А.М., Погожева Е.Ю. и др. Эффективность мелоксикама при острой боли в спине: данные наблюдательного неинтервенционного многоцентрового исследования. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;118(6):24-30.
  38. Каратеев А.Е., Погожева Е.Ю., Филатова Е.С., и др. Результаты российского многоцентрового исследования НОТА (НПВП для Обезболивания: Терапевтический Анализ). Терапевтический архив. 2018;90(6):65-73.
  39. Rai M.F, Brophy R.H, Sandell L.J. Osteoarthritis following meniscus and ligament injury: insights from translational studies and animal models. Curr Opin Rheumatol. 2019 Jan;31(1):70-9. doi: 10.1097/BOR.0000000 000000566
  40. Mattap S.M, Aitken D, Wills K, et al. Patellar tendon enthesis abnormalities and their association with knee pain and structural abnormalities in older adults. Osteoarthritis Cartilage. 2019 Mar; 27(3):449-458. doi: 10.1016/j.joca.2018.11.009 [Epub 2018 Dec 5]
  41. Филатова Е.С., Туровская Е.Ф., Алексеева Л.И., Эрдес Ш.Ф., Филатова Е.Г. Анализ патогенетических механизмов хронической суставной боли у больных ревматоидным артритом и остеоартрозом коленных суставов. Научно - практическая ревматология. 2014;52(6):631-5. https://doi.org/10.14412/1995-4484-2014-631-635
  42. Petersen K.K, Olesen A.E, Simonsen O, Arendt-Nielsen L. Mechanistic pain profiling as a tool to predict the efficacy of 3-week nonsteroidal anti - inflammatory drugs plus paracetamol in patients with painful knee osteoarthritis. Pain. 2018 Oct 26. doi: 10.1097/j.pain.0000000000001427 [Epub ahead of print.]
  43. De Oliveira Silva D, Rathleff M.S, Petersen K, et al. Manifestations of Pain Sensitization Across Different Painful Knee Disorders: A Systematic Review Including Meta - analysis and Metaregression. Pain Med. 2018 Nov 13. doi: 10.1093/pm/pny177 [Epub ahead of print.]

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies