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ISAKOS Biologics Series Part I Systematic Review| Volume 31, ISSUE 4, P793, April 2015

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Editorial Commentary: Arthritis Treatments for Pain

      Abstract

      Arthritis treatment must be analyzed with regard to outcome. Pain is one important outcome measure. Pain relief is variable among individual patients; individually discerning, personalized, or precision medical indications for nonsurgical treatment of osteoarthritis must be more specifically determined.
      Drs. Percope de Andrade, de Oliveira Campos, and Moreira de Abreu-e-Silva of the Federal University of Minas Gerais in Brazil, conclude, based on systematic review, that the use of nutraceuticals and viscosupplementation results in osteoarthritis pain relief.
      • Percope de Andrade M.A.
      • de Oliveira Campos T.V.
      • Moreira de Abreu-e-Silva G.
      Supplementary methods in the nonsurgical treatment of osteoarthritis.
      Glucosamine hydrochloride has no effect on pain, but glucosamine sulfate showed moderate effect. Diacerein (interleukin-1 beta inhibitor) results in pain relief, but is not approved by the United States FDA. Avocado and soy-bean unsaponificables may require additional research to determine pain relief long-term. Of note, we had never heard of diacerein before, nor did we know that avocado and soy, which we've certainly enjoyed eating this year, seem to help, plus we learned a new word—unsaponificables—which means components of an oily (oil, fat, wax) mixture that fail to form soaps when blended with sodium hydroxide (lye).
      Regarding viscosupplementation with hyaluronic acid, some published reviews report knee pain relief “despite AAOS recommendation against the use of hyaluronic acid in OA.”
      • Percope de Andrade M.A.
      • de Oliveira Campos T.V.
      • Moreira de Abreu-e-Silva G.
      Supplementary methods in the nonsurgical treatment of osteoarthritis.
      This has been our experience.
      • Lubowitz J.H.
      • Provencher M.T.
      • Poehling G.G.
      Congratulations and condemnations: Level I evidence prize for femoral tunnel position in ACL reconstruction, and AAOS clinical practice guidelines miss the mark-again.
      Viscosupplementation results in effective osteoarthritis pain relief in some patients. We may ask “Which patients?” and we find that the U.S. FDA defines “personalized” or “precision medicine” “as providing, ‘the right patient with the right drug at the right dose at the right time.’”

      United States Food and Drug Administration. Personalized Medicine. FDA's Unique Role and Responsibilities in Personalized Medicine. Available at http://www.fda.gov/scienceresearch/specialtopics/personalizedmedicine/default.htm. Accessed 8 February, 2015.

      One topic not covered in this review, but much discussed in the ISAKOS Biologics Supplement articles, is platelet-rich plasma.
      • Cugat R.
      • Cuscó X.
      • Seijas R.
      • et al.
      Biologic enhancement of cartilage repair: The role of platelet-rich plasma and other commercially available growth factors.
      Anecdotal reports of knee osteoarthritis pain relief are positive; we await published, higher level of evidence research.
      Finally, pain is important, but pain is a single outcome measure. It appears that the ultimate promise of biologics as an arthritis cure, with restoration of normal cartilage structure and function, seems far in the future, especially with regard to nonsurgical treatment.

      References

        • Percope de Andrade M.A.
        • de Oliveira Campos T.V.
        • Moreira de Abreu-e-Silva G.
        Supplementary methods in the nonsurgical treatment of osteoarthritis.
        Arthroscopy. 2015; 31: 785-792
        • Lubowitz J.H.
        • Provencher M.T.
        • Poehling G.G.
        Congratulations and condemnations: Level I evidence prize for femoral tunnel position in ACL reconstruction, and AAOS clinical practice guidelines miss the mark-again.
        Arthroscopy. 2014; 30: 2-5
      1. United States Food and Drug Administration. Personalized Medicine. FDA's Unique Role and Responsibilities in Personalized Medicine. Available at http://www.fda.gov/scienceresearch/specialtopics/personalizedmedicine/default.htm. Accessed 8 February, 2015.

        • Cugat R.
        • Cuscó X.
        • Seijas R.
        • et al.
        Biologic enhancement of cartilage repair: The role of platelet-rich plasma and other commercially available growth factors.
        Arthroscopy. 2015; 31: 777-783

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