Multimodal Multidisciplinary Management of Patients with Moderate to Severe Pain in Knee Osteoarthritis: A Need to Meet Patient Expectations
Nicola Veronese, Cyrus Cooper, Olivier Bruyère, Nasser M. Al‐Daghri, Jaime Branco, Etienne Cavalier, Sara Cheleschi, Mario Coelho da Silva Rosa, Philip G. Conaghan, Elaine Dennison, Maarten de Wit, Antonella Fioravanti, Nicholas R. Fuggle, I.K. Haugen, Gabriel Herrero‐Beaumont, Germain Honvo, Andrea Laslop, Radmila Matijević, Alberto Migliore, Ali Mobasheri, Jean‐Pierre Pelletier, María Concepción Prieto Yerro, Régis Radermecker, François Rannou, René Rizzoli, Jean‐Yves Reginster
Abstract
Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.