Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy -
Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
Eur J Phys Rehabil Med. 2019 Oct;55(5):658-664. doi: 10.23736/S1973-9087.19.05633-8. Epub 2019 May 15.
Osteoarthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, etiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic information, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations are not made.
Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA.
Delphi method Consenus Statement.
Italian Physicians having expertise in Osteoarthritis management.
A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centers specialized in osteoarthritis management took part in a Delphi process which was aimed at obtaining consensus statements among the participants.
Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy.
Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses.
This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA.
骨关节炎（OA）是一个日益受到关注的新兴主题。众所周知，它是一种可能导致严重长期残疾的慢性疾病，这给医疗保健系统带来了不断增加的成本。OA 的治疗选择多种多样：在选择最合适的治疗方法之前，应考虑定位、病因、分级和症状。目前，管理 OA 的一种现代方法涉及骨关节炎的对症治疗药物（SYSADOAs）。然而，虽然所有的制剂都可能声称提供治疗水平的葡萄糖胺或软骨素，但并非所有制剂都有临床证据支持。最近，欧洲骨质疏松症、骨关节炎和肌肉骨骼疾病临床和经济方面学会（ESCEO）发布了一份基于证据的文件，为从业者提供了最新的临床和经济信息，从而使他们能够优化膝骨关节炎的管理。根据该报告，只有结晶型硫酸葡萄糖胺和药用级硫酸软骨素被认为是治疗膝骨关节炎的一线药物，可替代对乙酰氨基酚。然而，一些 OA 指南并不一致，不推荐使用 SYSADOA，也许是因为它们通常被视为一类药物，而没有对制剂进行区分。
本研究旨在确定在使用 SYSADOA 时，患者选择、治疗药物选择和安全性方面的主要方面。
德尔菲共识声明法。
意大利骨关节炎管理专家。
成立了一个由来自意大利大学、公立医院、地区服务机构、研究机构和患者协会的 11 名专家组成的委员会。来自意大利许多专门治疗骨关节炎的医学中心的 63 名临床医生参加了德尔菲流程，旨在获得参与者之间的共识声明。
在以下主要主题下的陈述得到了广泛的共识：治疗指征；药物/医疗器械选择；治疗效果。
意大利骨关节炎治疗适宜性共识的结果似乎与 ESCEO 算法提出的逐步方法一致，根据几项独立的荟萃分析，结晶型硫酸葡萄糖胺显示出比其他基于葡萄糖胺的制剂更大的临床疗效。
本研究可作为帮助意大利医生使用 SYSADOA 治疗骨关节炎患者的实用参考工具。
