[en] Background: Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide.
Aim: Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice.
Methods: A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts.
Results: Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a
useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the
ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm.
Conclusion This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.
Disciplines :
Public health, health care sciences & services General & internal medicine
Author, co-author :
Yeap, Swan Sim
Tanavalee, Aree
Perez, Emmanuel C.
Tan, Maw Pin
Reyes, Bernadette Heizl M
Lee, Joon Kiong
Norhamdan, Mohd Yahaya
Vista, Evan S.
Chan, Wai Sin
Cong, Sy Bui
Tam, Pham Thi Thanh
Kaufman, Jean-Marc
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223
Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656
Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196
Cross M, Smith E, Hoy D et al (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73:1323–1330
Clynes MA, Jameson KA, Edwards MH et al (2019) Impact of osteoarthritis on activities of daily living: does joint site matter? Aging Clin Exp Res 31:1049–1056
Beaudart C, Biver E, Bruyère O et al (2018) Quality of life assessment in musculo-skeletal health. Aging Clin Exp Res 30:413–418
Bruyere O, Cooper C, Pelletier JP et al (2014) An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 44:253–263
Honvo G, Leclercq V, Geerinck A et al (2019) Safety of topical non-steroidal anti-inflammatory drugs in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging 36:45–64
Honvo G, Reginster J-Y, Rannou F et al (2019) Safety of intra-articular hyaluronic acid injections in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging 36:101–127
Cooper C, Chapurlat R, Al-Daghri N et al (2019) Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: what does the literature say? Drugs Aging 36:15–24
Honvo G, Reginster J-Y, Rabenda V et al (2019) Safety of symptomatic slow-acting drugs for osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging 36:65–99
Bruyere O, Cooper C, Pelletier J-P et al (2016) 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 45:S3–S11
Bruyère O, Honvo G, Veronese N et al (2019) An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 49:337–350
Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924
Zhang Z, Duan X, Gu J et al (2016) The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis is applicable to Chinese clinical practice: a consensus statement of leading Chinese and ESCEO osteoarthritis experts. Chin J Pract Intern Med 36:762–772
Denisov L, Tsvetkova E, Golubev G et al (2016) The European Society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis is applicable to Russian clinical practice: a consensus statement of leading Russian and ESCEO osteoarthritis experts. Hayчнo-пpaктичecкaя peвмaтoлoгия Rheumatol Sci Pract 54:641–652
Saengnipanthkul S, Waikakul S, Rojanasthien S et al (2019) Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment. Int J Rheum Dis 22:376–385
Bruyere O, Cooper C, Cutolo M et al (2017) International endorsement of the ESCEO algorithm for management of knee osteoarthritis in clinical practice. Semin Arthritis Rheum 47:e10
Xia W, Cooper C, Li M et al (2019) East meets West: current practices and policies in the management of musculoskeletal aging. Aging Clin Exp Res 31:1351–1373
Kucharz EJ, Szántó S, Goycheva MI et al (2019) Endorsement by Central European experts of the revised ESCEO algorithm for the management of knee osteoarthritis. Rheumatol Int 39:1117–1123
Fernandes L, Hagen KB, Bijlsma JW et al (2013) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 72:1125–1135
Cutolo M, Berenbaum F, Hochberg M et al (2014) Commentary on recent therapeutic guidelines for osteoarthritis. Semin Arthritis Rheum 44:611–617
Lauche R, Langhorst J, Dobos G et al (2013) A systematic review and meta-analysis of Tai Chi for osteoarthritis of the knee. Complement Ther Med 21:396–406
Zhang Q, Yue J, Golianu B et al (2017) Updated systematic review and meta-analysis of acupuncture for chronic knee pain. Acupunct Med 35:392–403
Towheed TE, Maxwell L, Judd MG et al (2006) Acetaminophen for osteoarthritis. Cochrane Database Syst Rev CD004257
Zhang W, Nuki G, Moskowitz RW et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 18:476–499
Bannuru RR, Schmid CH, Kent DM et al (2015) Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 162:46–54
Conaghan PG, Arden N, Avouac B et al (2019) Safety of paracetamol in osteoarthritis: what does the literature say? Drugs Aging 36:7–14
Lipworth L, Friis S, Mellemkjaer L et al (2003) A population-based cohort study of mortality among adults prescribed paracetamol in Denmark. J Clin Epidemiol 56:796–801
McCrae J, Morrison E, MacIntyre I et al (2018) Long-term adverse effects of paracetamol—a review. Br J Clin Pharmacol 84:2218–2230
De Wan M, Volpi G (1998) Method of preparing mixed glucosamine salts. Google Patents
Bruyère O, Cooper C, Al-Daghri NM et al (2018) Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res 30:111–117
Towheed TE, Maxwell L, Anastassiades TP, et al (2009) Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev CD002946
Reginster JY (2007) The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest. Arthritis Rheum 56:2105–2110
Eriksen P, Bartels EM, Altman RD et al (2014) Risk of bias and brand explain the observed inconsistency in trials on glucosamine for symptomatic relief of osteoarthritis: a meta-analysis of placebo-controlled trials. Arthritis Care Res (Hoboken) 66:1844–1855
Reginster JY, Deroisy R, Rovati LC et al (2001) Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 357:251–256
Pavelka K, Gatterova J, Olejarova M et al (2002) Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 162:2113–2123
Herrero-Beaumont G, Ivorra JA, Del Carmen TM et al (2007) Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum 56:555–567
Bruyere O, Altman RD, Reginster J-Y (2016) Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: evidence from real-life setting trials and surveys. Semin Arthritis Rheum 45:S12–S17
Kucharz EJ, Kovalenko V, Szanto S et al (2016) A review of glucosamine for knee osteoarthritis: why patented crystalline glucosamine sulfate should be differentiated from other glucosamines to maximize clinical outcomes. Curr Med Res Opin 32:997–1004
Clegg DO, Reda DJ, Harris CL et al (2006) Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 354:795–808
Runhaar J, Rozendaal RM, Middelkoop MV et al (2017) Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis 76:1862–1869
Reginster JL, Bruyere O, Cooper C (2017) Different glucosamine sulfate products generate different outcomes on osteoarthritis symptoms. Ann Rheum Dis 77:e39. 10.1136/annrheumdis-2017-212251
Bruyère O, Reginster J-Y, Honvo G et al (2019) Cost-effectiveness evaluation of glucosamine for osteoarthritis based on simulation of individual patient data obtained from aggregated data in published studies. Aging Clin Exp Res 31:881–887
Volpi N (2009) Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. J Pharm Pharmacol 61:1271–1280
Kahan A, Uebelhart D, De Vathaire F et al (2009) Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 60:524–533
Zegels B, Crozes P, Uebelhart D et al (2013) Equivalence of a single dose (1200 mg) compared to a three-time a day dose (400 mg) of chondroitin 4&6 sulfate in patients with knee osteoarthritis. Results of a randomized double blind placebo controlled study. Osteoarthr Cartil 21:22–27
Schneider H, Maheu E, Cucherat M (2012) Symptom-modifying effect of chondroitin sulfate in knee osteoarthritis: a meta-analysis of randomized placebo-controlled trials performed with structum((R)). Open Rheumatol J 6:183–189
Reginster JY, Dudler J, Blicharski T et al (2017) Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis 76:1537–1543
Honvo G, Bruyère O, Reginster J-Y (2019) Update on the role of pharmaceutical-grade chondroitin sulfate in the symptomatic management of knee osteoarthritis. Aging Clin Exp Res 31:1163–1167
Bannuru RR, Osani M, Vaysbrot E et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil 27:1578–1589
Arden NK, Perry TA, Bannuru RR et al (2021) Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nat Rev 17:59–66
Rossetti L, Hawkins M, Chen W et al (1995) In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats. J Clin Investig 96:132–140
Neil KM, Caron JP, Orth MW (2005) The role of glucosamine and chondroitin sulfate in treatment for and prevention of osteoarthritis in animals. J Am Vet Med Assoc 226:1079–1088
Muniyappa R, Karne RJ, Hall G et al (2006) Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes 55:3142–3150
Dostrovsky N, Towheed T, Hudson R et al (2011) The effect of glucosamine on glucose metabolism in humans: a systematic review of the literature. Osteoarthr Cartil 19:375–380
Runhaar J, Deroisy R, van Middelkoop M et al (2016) The role of diet and exercise and of glucosamine sulfate in the prevention of knee osteoarthritis: further results from the prevention of knee osteoarthritis in overweight females (PROOF) study. Semin Arthritis Rheum 45(4 Suppl):S42–S48
Gommans YM, Runhaar J, Jacobs ML et al (2017) The effect of prolonged glucosamine usage on HbA1c levels and new-onset diabetes mellitus in overweight and obese middle-aged women. Am J Med 130:e736
Veronese N, Cooper C, Reginster J-Y et al (2019) Type 2 diabetes mellitus and osteoarthritis. Semin Arthritis Rheum 49:9–19
Palleria C, Di Paolo A, Giofrè C et al (2013) Pharmacokinetic drug-drug interaction and their implication in clinical management. J Res Med Sci 18:601
Gallelli L, Galasso O, Falcone D et al (2013) The effects of nonsteroidal anti-inflammatory drugs on clinical outcomes, synovial fluid cytokine concentration and signal transduction pathways in knee osteoarthritis. A randomized open label trial. Osteoarthr Cartil 21:1400–1408
Burkhard K, Shapiro P (2010) Use of inhibitors in the study of MAP kinases. MAP kinase signaling protocols. Springer, Berlin, pp 107–122
Cepeda MS, Camargo F, Zea C et al (2006) Tramadol for osteoarthritis. Cochrane Database Syst Rev CD005522
Pelletier JP, Martel-Pelletier J, Rannou F et al (2016) Efficacy and safety of oral NSAIDs and analgesics in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum 45:S18–S21
Fuggle N, Curtis E, Shaw S et al (2019) Safety of opioids in osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging 36:129–143
Bruyere O, Ethgen O, Neuprez A et al (2012) Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study. Arch Orthop Trauma Surg 132:1583–1587
Ethgen O, Bruyere O, Richy F et al (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Jt Surg Am 86:963–974
Shan L, Shan B, Suzuki A et al (2015) Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Jt Surg Am 97:156–168
Nuesch E, Rutjes AW, Husni E et al (2009) Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev CD003115
Manchikanti L, Kaye AM, Knezevic NN et al (2017) Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: american society of interventional pain physicians (ASIPP) guidelines. Pain Phys 20:S3–S92
Veerapen K, Wigley RD, Valkenburg H (2007) Musculoskeletal pain in Malaysia: a COPCORD survey. J Rheumatol 34:207–213
