Giaretta Stefano, Magni Alberto, Migliore Alberto, Natoli Silvia, Puntillo Filomena, Ronconi Gianpaolo, Santoiemma Luigi, Sconza Cristiano, Viapiana Ombretta, Zanoli Gustavo
UOC Ortopedia e Traumatologia OC San Bortolo di Vicenza (AULSS 8 Berica), 36100 Vicenza, Italy.
Local Health Department, Desenzano sul Garda, 25015 Brescia, Italy.
J Clin Med. 2024 Aug 31;13(17):5176. doi: 10.3390/jcm13175176.
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.
预计到2050年，全球膝关节骨关节炎（KOA）病例将增加74.9%。目前，超过一半的患者对疼痛缓解情况仍不满意。本综述探讨了中重度KOA疼痛未满足的需求；它为改善管理提供了证据和见解。来自风湿病学、物理医学与康复、骨科、初级保健和疼痛治疗领域的意大利专家确定了几个关键问题。他们强调需要标准化的护理方案，以解决不同专科患者管理中的不一致问题。早期诊断至关重要，因为软骨对早期保护性和结构性治疗反应更好。更快获得物理治疗师评估以及为物理、康复和药物治疗（包括关节内注射治疗）提供报销，可减少获取方面的差距。人们对口服药物治疗的不良反应表示担忧，这凸显了对更安全替代方案的需求。随着时间的推移，患者对皮质类固醇和基于透明质酸的关节内注射治疗的满意度会降低，并且对于最佳关节内注射治疗方案尚无共识。手术应保留用于严重症状和影像学显示有KOA证据的情况，因为术后慢性疼痛会带来重大的社会和经济负担。专家们主张采用多学科方法，促进专科医生和全科医生之间的互动与合作，以提高意大利KOA护理和治疗的一致性。
