Jérémie Sellam1, Alice Courties2, Florent Eymard3, Stéphanie Ferrero4, Augustin Latourte5, Paul Ornetti6, Bernard Bannwarth7, Laurence Baumann8, Francis Berenbaum2, Xavier Chevalier3, Hang Korng Ea5, Marie-Christine Fabre9, Romain Forestier10, Laurent Grange11, Henri Lellouche12, Jérémy Maillet5, Didier Mainard13, Serge Perrot14, François Rannou15, Anne-Christine Rat16, Christian H Roux4, Eric Senbel17, Pascal Richette5. 1. Service de rhumatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Antoine, Sorbonne Université, Inserm UMRS_938, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: jeremie.sellam@aphp.fr. 2. Service de rhumatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Antoine, Sorbonne Université, Inserm UMRS_938, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. 3. Service de rhumatologie, Hôpital Henri Mondor, AP-HP, 94000 Créteil, France. 4. Service de rhumatologie, LAMHESS, université Cote d'Azur, CHU de Nice, 06000 Nice, France. 5. Service de rhumatologie, hôpital Lariboisière, AP-HP, 75010 Paris, France. 6. Service de rhumatologie, CHU de Dijon, 21000 Dijon, France. 7. Service de rhumatologie, CHU de Pellegrin, 33000 Bordeaux, France. 8. Université de Paris, 75006 Paris, France. 9. Association française de lutte anti-rhumatismale (AFLAR), 75013 Paris, France. 10. Centre de recherche rhumatologique et thermale, 73100 Aix-les-Bains, France. 11. Service de rhumatologie, AFLAR, CHU de Grenoble-Alpes, 38000 Grenoble/Paris, France. 12. Cabinet libéral et service de rhumatologie, hôpital Lariboisière, AP-HP, 75010 Paris, France. 13. Service de chirurgie orthopédique, CHU de Nancy, 54000 Nancy, France. 14. Centre d'évaluation et traitement de la douleur, hôpital Cochin, AP-HP, 75014 Paris, France. 15. Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du Rachis, centre-université de Paris, hôpital Cochin, université de Paris, AP-HP, 75014 Paris, France. 16. Service de rhumatologie, CHU Caen, 14000, Caen, France. 17. Cabinet libéral et service de rhumatologie, Hôpital Sainte-Marguerite, 13000, Marseille, France.
Abstract
OBJECTIVES: To establish recommendations for pharmacological treatment of knee osteoarthritis specific to France. METHODS: On behalf of the French Society of Rheumatology (SFR), a bibliography group analyzed the literature on the efficacy and safety of each pharmacological treatment for knee osteoarthritis. This group joined a multidisciplinary working group to draw up recommendations. Strength of recommendation and quality of evidence level were assigned to each recommendation. A review committee gave its level of agreement. RESULTS: Five general principles were established: 1) need to combine pharmacological and non-pharmacological treatments, 2) personalization of treatment, 3) symptomatic and/or functional aim of pharmacological treatments, 4) need to regularly re-assess the treatments and 5) discussion about arthroplasty if medical treatment fails. Six recommendations involved oral treatments: 1) paracetamol should not necessarily be prescribed systematically and/or continuously, 2) NSAIDs, possibly as first-line, 3) weak opioids, 4) strong opioids, 5) symptomatic slow-acting drugs of osteoarthritis, and 6) duloxetine (off-label use). Two recommendations involved topical agents (NSAIDs and capsaicin<1%). Three recommendations involved intra-articular treatments: corticosteroid or hyaluronic acid injections that can be proposed to patients. The experts did not draw a conclusion about the benefits of platelet-rich plasma injections. CONCLUSION: These are the first recommendations of the SFR on the pharmacological treatment of knee osteoarthritis.
OBJECTIVES: To establish recommendations for pharmacological treatment of knee osteoarthritis specific to France. METHODS: On behalf of the French Society of Rheumatology (SFR), a bibliography group analyzed the literature on the efficacy and safety of each pharmacological treatment for knee osteoarthritis. This group joined a multidisciplinary working group to draw up recommendations. Strength of recommendation and quality of evidence level were assigned to each recommendation. A review committee gave its level of agreement. RESULTS: Five general principles were established: 1) need to combine pharmacological and non-pharmacological treatments, 2) personalization of treatment, 3) symptomatic and/or functional aim of pharmacological treatments, 4) need to regularly re-assess the treatments and 5) discussion about arthroplasty if medical treatment fails. Six recommendations involved oral treatments: 1) paracetamol should not necessarily be prescribed systematically and/or continuously, 2) NSAIDs, possibly as first-line, 3) weak opioids, 4) strong opioids, 5) symptomatic slow-acting drugs of osteoarthritis, and 6) duloxetine (off-label use). Two recommendations involved topical agents (NSAIDs and capsaicin<1%). Three recommendations involved intra-articular treatments: corticosteroid or hyaluronic acid injections that can be proposed to patients. The experts did not draw a conclusion about the benefits of platelet-rich plasma injections. CONCLUSION: These are the first recommendations of the SFR on the pharmacological treatment of knee osteoarthritis.