Comments on 'OARSI guidelines for the non-surgical management of knee osteoarthritis'

摘要

To the Editor: The 2014 OARSI Guidelines for the management of hip and knee osteoarthritis (OA) with pharmacological therapies are indeed improved by reference to the 2008/2010 OARSI recommendations because the presence or absence of co-morbidities is taken into account.However, by defining treatment appropriateness simply as appropriate, uncertain and not appropriate, the 2013 recommendations do not specify how to treat the OA in a significant number of patients: those with moderate and high co-morbidities risks. For these patients, the appropriateness of any oral treatment is uncertain, except IACS and duloxetine. To illustrate the importance of the population with OA and co-morbidity risks, among the US population with OA, less than 65 years old, the prevalence of metabolic syndrome is 59%, hypertension 75%, abdominal obesity 63%, hyper-glycemia 30%, and renal impairment 37%; indeed, aging and obesity should also be considered co-morbidities.