Non Pharmacological Therapies in the Management of Osteoarthritis


by

Yves Henrotin

DOI: 10.2174/97816080531791120101
eISBN: 978-1-60805-317-9, 2012
ISBN: 978-1-60805-541-8



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Indexed in: Scopus

Osteoarthritis is a chronic disease prevalent among the elderly. Its most prominent feature is the progressive destruction of articula...[view complete introduction]

Table of Contents

Foreword

- Pp. i

Francis Berenbaum

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Preface

- Pp. ii

Yves Henrotin

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List of Contributors

- Pp. iii-iv (2)

Yves Henrotin

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The Specific Challenges of Conducting High Quality Clinical Trials to Assess Conservative Non Pharmacological Treatments of Osteoarthritis

- Pp. 3-12 (10)

M. Marty

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Nonpharmacological Approaches in Management of Hip and Knee Osteoarthritis-Related Pain

- Pp. 13-20 (8)

S. Perrot

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Non-Pharmacological Therapies for the Management of Osteoarthritis in Guidelines: Discrepancies and Translating Evidence in Practices

- Pp. 21-34 (14)

Y. Henrotin

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Weight Loss: Preventive and Therapeutic Effects in Obese Patients with Osteoarthritis

- Pp. 35-39 (5)

P. Richette

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The Role of Land-Based Exercise and Manual Therapy in the Management of Osteoarthritis

- Pp. 40-63 (24)

K. Bennell, M. Hunt and R. Hinman

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Components of Crenobalneotherapy for Knee Osteoarthritis: A Systematic Review

- Pp. 64-80 (17)

R. Forestier and A. Françon

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Acupuncture and Osteoarthritis: Practices and Evidences

- Pp. 81-93 (13)

K. Sanchez, S. Poiraudeau and F. Rannou

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Bracing for Osteoarthritis

- Pp. 94-102 (9)

J. Beaudreuil

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Insoles and Footwear in the Management of Knee Osteoarthritis

- Pp. 103-114 (12)

R.S. Hinman and K.L. Bennell

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Nutraceuticals: From Research to Legal and Regulatory Affairs

- Pp. 115-126 (12)

A. Mobasheri, K. Asplin, A. Clutterbuck and M. Shakibaei

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Recent Advances and Perspectives

- Pp. 127-129 (3)

K. Bennell, F. Rannou and Y. Henrotin

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Index

- Pp. 130-131 (2)

Yves Henrotin, Kim Bennell and Francois Rannou

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Foreword

Considered as inevitable for decades, osteoarthritis (OA) is now regarded as a "real" disease rather than an unavoidable marker of aging, like white hairs or wrinkles. This changing face of the disease is mainly due to researchers and to patients: (i) researchers, because they have demonstrated that OA is not the simple consequence of passive wear and tear of the cartilage but the result of biological events, with many degradative and inflammatory processes involving multiple tissues, cell types, chemical and physical mediators, (ii) patients, because they rejuvenate year after year. Indeed, the age corresponding to the so-called "third age" has moved back each year because of an increased life expectancy (an increase of 2 months every year). How can we now consider a 65 year-old patient as an “old” person (although this was the case even 30 years ago)?! Thus, patients' behaviour is changing, fortunately more demanding, requiring more effective treatments for their symptoms, pain and function. They now need their knees, hips, and hands for their profession, travels, daily activities, sports, etc. Based on these patients’ requests and given the exponential increase in incidence and prevalence of OA expected in the next years, societal costs will soon be abysmal. The three main risk factors for OA, aging, obesity and trauma, can only be amplified in the coming decade. The new lifestyles observed in industrialized countries lead to new leisure activities or sports that increase lower limb injuries, or instead multiply the time spent in front of screens of any kind that increases weight proportional to the sedentary time. It is therefore urgent to anticipate this situation by implementing methods of prevention possibly cheaper than potential targeted drugs to come for cure.

All national and international recommendations for the management of OA stress the importance of not neglecting the non-pharmacological treatments, not only for primary prevention, but also for secondary prevention. This book, consisting of chapters written by authors, who are international leaders in this field, highlights all the potential of non-pharmacological treatments for OA, from weight loss, to manual therapy, exercises, educational programs, crenobalneotherapy, acupuncture, insoles, footwear and dietetic supplements. The added-value of this book is undeniably the effort to keep an evidence-based approach in all the chapters although this is challenging: it is much more difficult to conduct studies methodologically perfect for these types of intervention than it is for drugs: placebo groups, blinding, randomisation are uneasy to define, as Dr. Marty’s chapter points out

I am grateful to Professor Yves Henrotin for the coordination of such a book that will be a must to serve as a source of information for health care professionals, primary care physicians, orthopaedists, rheumatologists, geriatricians, physiotherapists, and any other professionals committed to helping all these patients who have to cope with such a painful and disabling disease.

Pr Francis Berenbaum
Head of the Department of Rheumatology
Faculty of Medicine Pierre & Marie Curie Paris VI Saint-Antoine hospital, AP-HP
184 rue du faubourg Saint-Antoine
75012 Paris
France


Preface

Osteoarthritis (OA) is one of the most prevalent and chronic diseases affecting the elderly. Its most prominent feature is the progressive destruction of articular cartilage which results in impaired joint motion, severe pain and ultimately disability. Its prevalence and its impact on daily life pose a significant public health problem. Today, a cure for OA remains elusive and the management of OA is largely palliative focusing on the alleviation of symptoms. Current recommendations for the management of OA include a combination of pharmacological and non-pharmacological treatments. The term “non-pharmacological” includes physical therapy and rehabilitation, “nutraceuticals” or food supplements and surgical treatments. This book focuses on physical therapies, rehabilitation and nutraceuticals, while surgical treatments are not discussed. All guidelines on OA management highlight the importance of weight loss and physical activity to improve the functional status of OA patients. Although they are not recommended, a number of other therapies are commonly used by physicians and physical therapists in their daily practice. These techniques are not recommended because their efficacy is not evidenced by strong clinical trials. This category includes electrotherapy, ultrasound, electromagnetic field, spa, hydrotherapy, etc. The clinical relevance of these techniques and the difficulties in conducting high quality trials assessing their efficacy are stated by authors. This book is really a guide of good clinical practice for all health care professionals in charge of patients with OA.

Pharmacological management of OA is dominated by analgesic, nonsteroidal anti-inflammatory drugs, and Symptomatic Slow Acting Drugs (SYSADOA) which constitute a new class of drugs characterised by a slow action on OA symptoms and a good tolerability. Some SYSADOA are nutraceuticals (i.e. glucosamine, chondroitin sulphate, avocado/soybean unsaponifiable) and are provided as dietary supplements or prescribed drugs according to the country and the product specifications. The absence of a clear definition and requirements for registration of nutraceuticals throws the scientists and practitioners into confusion. Often data coming from preclinical and clinical studies of prescribed drugs are extrapolated to over-the-counter products which differ considerably in source, formula, purity, rhythm and dose administrated. In fact, more than 30 nutraceutical products are marketed as potentially active in OA but few have demonstrated their efficacy and safety in human clinical trials. Clearly, in terms of regulations, there is a need to resolve the general confusion about whether nutraceuticals are food supplements or medicines. This book aims to review the available scientific evidence supporting the efficacy, and explaining the mechanism of action of nutraceuticals targeting OA. It also gives the recent advances in term of nutraceuticals nomenclature, classification and regulation.

Prof. Yves Henrotin
Bone and cartilage Research Unit (BCRU),
Department of Motricity Sciences,
University of Liège,
Institute of Pathology, level +5,
CHU Sart-Tilman,
4000 Liège,
Belgium

List of Contributors

Editor(s):
Yves Henrotin
University of Liège
Belgium




Co-Editor(s):
Yves Henrotin
University of Liège
Belgium


Kim Bennell
University of Melbourne
Australia


Francois Rannou
Université Paris Descartes
France




Contributor(s):
Asplin Katie
Musculoskeletal Research Group, School of Veterinay Medecine and Science
Faculty of Medicine and Health sciences, University of Nottingham
Sutton Bonington Campus
Sutton Bonington, LE12 5RD
United Kingdom


Beaudreuil Johann
Service de Rhumatologie
Hôpital Lariboisière
AP-HP, Université Paris 7
Paris
France


Bennell Kim
Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy
School of Health Sciences, University of Melbourne
Melbourne
VLC, 3010
Australia


Berenbaum Francis
Pierre & Marie Curie University Paris VI
AP-HP Saint-Antoine Hospital
Paris
France


Clutterbuck Abigail
Musculoskeletal Research Group
School of Veterinay Medecine and Science, Faculty of Medicine and Health sciences
University of Nottingham, Sutton Bonington Campus
Sutton Bonington, LE12 5RD
UK


Forestier Romain
Centre de recherche rhumatologique et thermale
15, avenue Charles de Gaulle
Aix-les-Bains, 73100
France


Francon Alain
Centre de recherche rhumatologique et thermale
15, avenue Charles de Gaulle
Aix-les-Bains, 73100
France


Henrotin Yves
Bone and Cartilage Research Unit (BCRU), Department of Motricity Sciences
University of Liège, Institute of Pathology
level +5, CHU Sart-Tilman
Liège, 4000
Belgium


Hunt Michael
Department of Physical Therapy
University of British Columbia
Vancouver
Canada


Hinman Rana
Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy
University of Melbourne
Melbourne
VLC, 3010
Australia


Marty Marc
Rheumatology department
Henri Mondor Hospital
Creteil
France


Mobasheri Ali
Musculoskeletal Research Group, School of Veterinay Medecine and Science
Faculty of Medicine and Health sciences
University of Nottingham, Sutton Bonington Campus
Sutton Bonington, LE12 5RD
UK


Perrot Serge
Service de Médecine Interne et Thérapeutique, INSERM U 987
Hotel Dieu Hospital
1 Place du Parvis Notre Dame
Paris, 75004
France


Poiraudeau Serge
AP-HP, Service de Médecine Physique et Réadaptation
Hôpital Cochin, Université Paris Descartes, INSERM
Institut Fédératif de Recherche sur l’Handicap (IFR 25)
27 rue du faubourg Saint-Jacques
Paris Cedex 14, 75679
France


Rannou François
Université Paris Descartes, INSERM
Institut Fédératif de Recherche sur le Handicap (IFR 25)
27 rue du Faubourg Saint-Jacques
Paris Cedex 14, 75679
France


Richette Pascal
Université Paris VII, UFR Médicale, Assistance Publique-Hôpitaux de Paris
Hôpital lariboisière, fédération de Rhumatologie
Paris Cedex 10, 75475
France


Sanchez Katherine
AP-HP, Service de Médecine Physique et Réadaptation
Hôpital Cochin, Université Paris Descartes, INSERM
Institut Fédératif de Recherche sur l’Handicap (IFR 25)
27 rue du faubourg Saint-Jacques
Paris Cedex 14, 75679
France


Shakibaei Mehdi
Musculoskeletal Research Group
Institute of Anatomy
Ludwig-Maximilian - University of Munich
Munich, 80336
Germany




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