Congress updates

Assessment of osteoarthritis-associated pain

Over 20% of chronic pain globally is associated with osteoarthritis (OA), with an increasing incidence associated with age and obesity. For many years, OA-associated pain was neglected, in part because of false beliefs on mechanisms and treatments. Currently, it is associated with important unmet needs, including suboptimal pain assessment.

In the videos below, the expert panel canvas key considerations in the best-practice assessment of OA-associated pain.

Guidelines for treating osteoarthritis-associated pain

There is a significant unmet need in the management of osteoarthritis (OA) and chronic pain associated with OA. Given uncertainty regarding the status of international medical conferences, healthcare providers may find it challenging to stay current with the latest recommendations in OA guidelines, and the emerging data for research and therapies that are under development to treat OA-associated pain.

The short videos in this section summarise the latest key guideline updates for managing OA-associated pain.

Knowledge gaps and new treatments in osteoarthritis-associated pain

Chronic pain disproportionately affects women, and evidence shows that differences exist between women and men in experience, management and treatment for pain conditions, such as osteoarthritis (OA).

In this roundtable meeting, OA experts delve deeper into some of the knowledge gaps and new treatments for OA-associated pain, including impact on women and the use of hormone replacement therapy (HRT), among other important issues.

Meet the experts

Professor Tonia Vincent - Roundtable Chair
Director, Centre for Osteoarthritis Pathogenesis, University of Oxford, UK
Professor Vincent studied medicine at University College London, qualifying in 1993. She trained as a junior doctor in London, later specialising in Rheumatology.

Professor Martin Englund
Project Manager, Lund OsteoArthritis Division - Clinical Epidemiology Unit, Lund University, Sweden
Professor Englund is an MD (1998) and epidemiologist with a PhD in Orthopaedics (2004).

Dr Theresa Burkard
Postdoctoral Researcher, Department of Chemistry and Applied Biosciences, Federal Institute of Technology, Zurich, Switzerland
Dr Burkard is a pharmacist by training and obtained a PhD in Epidemiology in 2019.

Meet the expert

Professor Tonia Vincent
Director, Centre for Osteoarthritis Pathogenesis,
University of Oxford, UK Professor Vincent studied medicine at University College London, qualifying in 1993. She trained as a junior doctor in London, later specialising in Rheumatology.

Tramadol’s mortality risk could outweigh its benefits

According to a large population-based study in Canada, patients with OA treated with tramadol presented a 20–50% higher risk of death during the first year of treatment, compared with patients receiving NSAIDs.

Within a year of starting treatment with tramadol, there was a 20% increase in all-cause mortality when compared with naproxen (death rate of 21.5 vs 17.8 per 1,000 person-years, respectively; hazard ratio [HR] of 1.2). Similar results were observed when comparing tramadol with diclofenac (HR, 1.3) and cyclooxygenase (COX)-2 inhibitors (HR, 1.5). However, all-cause mortality was lower with tramadol than codeine (21.5 vs 25.5 per 1,000 person-years; HR, 0.8).

These findings add further weight to the excess mortality risk of tramadol highlighted last year by Zeng et al. in JAMA³ [link: dx.doi.org/10.1001/jama.2019.1347]

More information about the study

Self-management app may positively impact the health of OA patients

Use of a self-management smartphone app (Dr Bart) has positive effects on activities of daily living, pain and symptoms in patients with knee and/or hip OA, compared with usual care⁴.

In this randomised online survey study, the primary outcome of the number of knee/hip-related secondary healthcare consultations vs previous 6 months was not met. However, use of app technology provides an ongoing health benefit and supports self-management in OA⁵.

More information about the study

EULAR gives pointers on best practices for intra-articular injection

New EULAR taskforce recommendations for intra-articular (IA) treatment in everyday practice aim to improve quality of care where no previous guidelines exist.

Currently, there is wide variation in the methods for applying IA therapies. In an effort to facilitate uniformity, five overarching principles were developed by expert consensus:

1. Recognising that IA therapies may not be interchangeable across indications
2. Improving patient-centered outcomes
3. Understanding the value of effective communication
4. Managing patient expectations
5. Providing an optimal clinical setting for performing injections

The taskforce recommendations also provide the following points of advice for care surrounding IA injections:

• Patient consent
• The need for patients and clinicians to make an informed and shared decision
• The importance of imaging and injection accuracy
• Acknowledging that IA injections may be given by a range of health care professionals

More information about the study

No benefit with hydroxychloroquine for inflammatory, erosive hand OA

The OA TREAT investigators demonstrated that hydroxychloroquine does not improve pain, function or radiographic progression in patients with inflammatory and erosive hand OA².

In the first large, randomised, placebo-controlled trial focusing on erosive hand OA, pain and hand function improved to a similar degree among patients receiving either standard therapy plus hydroxychloroquine (200–400 mg/day) or standard therapy and placebo.

Mean function scores on the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) improved from 58.5 to 48.1 points and 57.8 to 51.3 points in the hydroxychloroquine and placebo arms, respectively. At 1 year, mean pain scores improved to 26.7 points and 26.5 points from baseline in the hydroxychloroquine and placebo arms, respectively. Furthermore, there was also no significant difference in radiographic progression between treatment groups.

Although hydroxychloroquine was associated with a significantly lower mean erythrocyte sedimentation rate, compared with placebo, duration of morning stiffness was significantly prolonged (30.2 vs 16.3 minutes for hydroxychloroquine and placebo, respectively).

More information about the study

The recent update of the 2019 American College of Rheumatology (ACR)/Arthritis Foundation (AF) guidelines for the comprehensive management of osteoarthritis (OA) of the Hand, Hip, and Knee contained a number of notable changes and recommendations⁷.

Below you can discover the key changes to the guidelines as well as important considerations in OA physical therapy. Also stay up to date on studies comparing physical therapy and glucocorticoids, the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on coronavirus disease 2019 (COVID-19) susceptibility, anti-nerve growth factor (anti-NGF) efficacy and safety, and research into anti-interleukin-6 (anti-IL6) treatments.

Key changes to the 2019 ACR/AF guidelines

What are the key changes to the 2019 ACR/AF guidelines?

Gain an overview of the key changes to the 2019 ACR/AF guidelines for the management of OA, from the increased emphasis on NSAIDs to nonpharmacological approaches, such as Tai Chi.

What are the essential considerations when recommending physical therapies?

Find out how creating a personalised physical therapy regimen is vital for increasing and enhancing joint mobility in patients with hand, hip and knee OA.

Why is personalisation important for OA patients during physical therapy?

Learn about maximising adherence to physical therapy through personalised regimens that are tailored to individual patient lifestyles.

Physical therapy vs. glucocorticoid injection

How does physical therapy compare to glucocorticoid injection for knee OA?

While glucocorticoid injections and physical therapy are both known to confer a clinical benefit in knee OA, gain an insight into why recent research is investigating the differences in pain relief between these two treatments¹.

What was the study population in Deyle et al., and what were their treatments?

Have a deeper look at the Deyle et al. study design and learn about the military patients who received glucocorticoid injection or underwent physical therapy for knee OA⁸.

What did Deyle et al. find  when comparing physical therapy to glucocorticoids for knee OA?

Find out which treatment was superior in relieving knee OA symptoms at 1 year for military patients receiving glucocorticoid injections or undergoing physical therapy⁸.

What were the key results in the Deyle et al. study comparing physical therapy to glucocorticoids?

Short on time? Learn the key messages for clinicians from the Deyle et al. study, including the short-term and long-term benefits of these treatments and the importance of physical therapy⁸.

NSAIDs and COVID-19

Do NSAIDs increase the susceptibility to developing COVID-19 more than other analgesics?

Do NSAIDs increase susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by upregulating ACE2 receptors? See how new clinical studies are investigating if NSAIDs present a risk to patients⁹.

How are NSAIDs being investigated to determine their impact on developing COVID-19?

Explore the design of the propensity score-matched cohort study by Chandan et al. that investigated the impact of co-codamol and co-dydramol on COVID-19 susceptibility⁹.

What are the results of the study into NSAIDs and susceptibility to COVID-19?

Hear the recent results of the Chandan et al. study that showed no increase in the rate of COVID-19 cases or all-cause mortality in OA patients treated with NSAIDs⁹.

Anti-IL-6 treatments for OA

What are the latest data on the use of anti-IL-6 treatments for OA?

Improve your understanding of the latest research into anti-IL-6 treatments for hand OA and find out the results of a recently completed clinical trial that investigated the effect of tocilizumab in patients with hand osteoarthritis (TIDOA)¹³.