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Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis. Recommendations from the EUROpean VIScosupplementation COnsensus Group (EUROVISCO).R. Raman, Y. Henrotin, X. Chevalier, A. Migliore, J. Jerosch, J. Montfort, H. Bard, D. Baron, P. Richette, T. Conrozier. Cartilage. February-01-2017. Doi: 10.1177/1947603517693043

The paper « Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis » has been published in Cartilage after the 2nd edition of the LABRHA European Board on Viscosupplementation which took place in Lyon the 17th and 18th September 2015 and at which ten experts from Belgium, France, Germany, Italy, Spain and UK participated (EUROVISCO group).

The task force looked during this meeting at issues regarding re-treatment with Viscosupplementation (VS) in knee osteoarthritis. An attempt was made to reach consensus on 88 issues within 18 statements among which:
  • How can we define « success » and « failure » of the treatment?
  • When and how re-treat patients successfully treated by a previous VS?
  • When and how to re-treat patients in whom VS previously failed?
  • What management options can be suggested when the patient experienced moderate adverse reactions following a previous VS?
  • What is the role of serum and urine biomarkers in re-treatment with HA?

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At the end of the meeting, two decisions algorithms have been drawn up to help the physicians decide what to do in their daily practice in the following two cases: 
  • in case of failure of a previous VS
  • in case VS was previously successful

Results
In case of failure, the authors draw attention to the need of a rigorous clinical and radiological analysis, and consider evidence-based medicine. When VS was previously successful, retreatment can be considered after recurrence or increase in pain. However, in subjects with high risk of disease progression, in young patients, and in professional sportsmen, retreatment could be considered systematically, because of the probability of hyaluronic acid to slow osteoarthritis progression. Evidence on soluble biomarkers was not considered as enough strong to support their use as decision tools for patient retreatment.

Conclusion
The decision algorithms are intended to facilitate consideration of the therapeutic options, in patients with knee osteoarthritis previously treated with VS.

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Have a look at the Poster on this topic displayed at the OARSI Congress in April 2017

 

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