RESUMO
BACKGROUND: The aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over 1 to 2 years in people with painful medial knee osteoarthritis. METHODS: A longitudinal study was conducted within a randomised controlled trial, the "Long-term Evaluation of Glucosamine Sulfate" (LEGS study). Recruitment occurred in 2007-2009, with 1- and 2-year follow-up assessments by blinded assessors. Community-dwelling people with chronic knee pain (≥4/10) and medial tibiofemoral narrowing (but retaining >2mm medial joint space width) on radiographs were recruited. From 605 participants, follow-up data were available for 498 (82%, mean [sd] age 60 [8] years). Risk factors evaluated at baseline were pain, physical function, use of non-steroidal anti-inflammatory drugs (NSAIDs), statin use, not meeting physical activity guidelines, presence of Heberden's nodes, history of knee surgery/trauma, and manual occupation. Multivariable logistic regression analysis was conducted adjusting for age, sex, obesity, high blood pressure, allocation to glucosamine and chondroitin treatment, and baseline structural disease severity (Kellgren and Lawrence grade, joint space width, and varus alignment). Radiographic osteoarthritis progression was defined as joint space narrowing ≥0.5mm over 1 to 2 years (latest follow-up used where available). RESULTS: Radiographic osteoarthritis progression occurred in 58 participants (12%). Clinical factors independently associated with radiographic progression were the use of NSAIDs, adjusted odds ratios (OR) and 95% confidence intervals (CI) 2.05 (95% CI 1.1 to 3.8), and not meeting physical activity guidelines, OR 2.07 (95% CI 0.9 to 4.7). CONCLUSIONS: Among people with mild radiographic knee osteoarthritis, people who use NSAIDs and/or do not meet physical activity guidelines have a greater risk of radiographic osteoarthritis progression. TRIAL REGISTRATION: ClinicalTrials.gov , NCT00513422 . This original study trial was registered a priori, on August 8, 2007. The current study hypothesis arose before inspection of the data.
Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Progressão da Doença , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Dor , Fatores de RiscoRESUMO
OBJECTIVE: To determine if the dietary supplements, glucosamine and/or chondroitin, result in reduced joint space narrowing (JSN) and pain among people with symptomatic knee osteoarthritis. METHODS: A double-blind randomised placebo-controlled clinical trial with 2-year follow-up. 605 participants, aged 45-75â years, reporting chronic knee pain and with evidence of medial tibio-femoral compartment narrowing (but retaining >2â mm medial joint space width) were randomised to once daily: glucosamine sulfate 1500â mg (n=152), chondroitin sulfate 800â mg (n=151), both dietary supplements (n=151) or matching placebo capsules (n=151). JSN (mm) over 2â years was measured from digitised knee radiographs. Maximum knee pain (0-10) was self-reported in a participant diary for 7â days every 2â months over 1â year. RESULTS: After adjusting for factors associated with structural disease progression (gender, body mass index (BMI), baseline structural disease severity and Heberden's nodes), allocation to the dietary supplement combination (glucosamine-chondroitin) resulted in a statistically significant (p=0.046) reduction of 2-year JSN compared to placebo: mean difference 0.10â mm (95% CI 0.002â mm to 0.20â mm); no significant structural effect for the single treatment allocations was detected. All four allocation groups demonstrated reduced knee pain over the first year, but no significant between-group differences (p=0.93) were detected. 34 (6%) participants reported possibly-related adverse medical events over the 2-year follow-up period. CONCLUSIONS: Allocation to the glucosamine-chondroitin combination resulted in a statistically significant reduction in JSN at 2â years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo. TRIAL REGISTRATION CLINICALTRIALSGOV IDENTIFIER: NCT00513422; http://www.clinicaltrials.gov.
Assuntos
Sulfatos de Condroitina/uso terapêutico , Suplementos Nutricionais , Glucosamina/uso terapêutico , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Progressão da Doença , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Resultado do TratamentoRESUMO
BACKGROUND: Neuropathic pain is described as burning, painful, cold or electric shocks and may be associated with tingling, pins and needles, numbness or itching. OBJECTIVE: This article summaries the diagnosis and management of four common neuropathic pain presentations. DISCUSSION: A validated diagnostic screening tool can help identify patients with neuropathic pain. A systematic approach to clinical assessment and investigation will clarify the diagnosis. Good glycaemic control is important in the prevention and management of diabetic polyneuropathy; management options include antidepressants, gabapentinoids and controlled release opioids. Pain that lasts for more than 3 months after the onset of a herpes zoster infection is called 'postherpetic neuralgia'; management options include prevention with vaccination, early antiviral treatment and gabapentinoids, tricyclic antidepressants, controlled release opioids, capsaicin cream and lignocaine patches. In trigeminal neuralgia, patients complain of severe brief episodes of pain in the distribution of one or more branches of the fifth cranial nerve; first line management is with carbamazepine. Complex regional pain syndrome is diagnosed using the Budapest Diagnostic Criteria. Few clinical trials are available to guide the treatment of complex regional pain syndrome, which includes pharmacological and surgical options.