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this being more prevalent in women&#44; and the lumbar spine being the most affected joint&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> OA is considered the third leading cause of years lived with disability and entails high socioeconomic costs for health systems&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In Spain&#44; it is estimated that the total cost of hip and knee OA is between 1 and 2&#46;5&#37; of GDP&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The treatment of OA is a challenge for health professionals&#44; since there is no cure for the disease&#46; Current treatments focus on non-pharmacological&#44; pharmacological and surgical approaches&#44; the latter being recommended when conservative treatment is ineffective and where there is a major impact on quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this direction&#44; the use of a group of drugs known as SYSADOAs &#40;<span class="elsevierStyleItalic">SYmptomatic Slow-Acting Drugs for Osteoarthritis</span>&#41; has been proposed as a therapy option for the treatment of pain&#44; stiffness and functional capacity in OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; although there is widespread use in Spain of SYSADOAs drugs such as glucosamine &#40;GS&#41; and chondroitin sulphate &#40;CS&#41;&#44; their efficacy and safety have been the subject of controversy in the scientific literature in recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> On the one hand&#44; some studies have suggested that SYSADOAs may be effective in the treatment of OA&#44; especially in terms of reducing pain&#44; improving joint function&#44; and reducing the consumption of anti-inflammatory drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> On the other hand&#44; several systematic reviews have questioned the efficacy of SYSADOAs&#44; suggesting that they may have modest or no effects on pain and joint function&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> Due to the disparity in the results of clinical trials and meta-analyses in the use of GS and CS&#44; there is currently no consensus in the scientific evidence as to their efficacy in improving pain or functionality in people with OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to the scientific controversy surrounding the efficacy of SYSADOAs&#44; there is also a debate across the media over the financing of these treatments by the Spanish National Health System &#40;SNS in its Spanish acronym&#41;&#46; At the end of 2019&#44; the Directorate General for the Common Portfolio of SNS and Pharmacy Services &#40;DGCCSyF&#41;&#44; under the Ministry of Health&#44; began the processes of defunding these drugs&#46; Since then&#44; patient associations&#44; the Spanish Society of Health Professionals and civil society have all spoken out through the media&#44; creating a social debate&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In 2020&#44; OAFI &#40;International Osteoarthritis Foundation&#41; initiated legal proceedings with the lodging of an appeal against this de-financing move&#44; which was then temporarily paralysed&#46; Taking into account the importance of recommendations for effective and safe treatments for OA&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and the relevance of health-related information in the media&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> this study aims to qualitatively and quantitatively analyse the controversy over the use and financing of SYSADOAs drugs for OA patients in the Spanish mainstream media and social networks&#46; In addition&#44; another of its purposes is to describe the main positions of public bodies&#44; professional societies and patient organisations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study was based&#44; on the one hand&#44; on the analysis of the content of articles published in the press&#44; posts in digital media&#44; statements from public bodies and posts on social networks from the 1st of January 2018 to the 1st of January 2023&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In relation to the search for articles in the press&#44; a search was carried out in the 5 generalist newspapers with the highest number of readers in Spain in 2021&#44; according to the General Media Study by the AIMC &#40;Spanish Association for Media Research&#44; 2021&#41;&#46; The search was run in both the digital and print versions of the 5 selected newspapers&#44; including the supplements of each newspaper&#46; To this end&#44; the search was undertaken through the MyNews tool&#44; a digital newspaper library belonging to the Spanish press&#46; The keywords used were &#34;osteoarthritis&#34;&#44; &#34;SYSADOA&#34;&#44; &#34;arthrosis&#34;&#44; &#34;treatment&#34;&#44; &#34;financing&#34; and &#34;drug&#34;&#44; in different combinations using the Boolean operators AND and OR&#46; Articles were included in the study if they met the following criteria&#58; 1&#41; they provided information in the title&#44; subtitle&#44; or body of the article concerning OA and the use of SYSADOAs in OA disease&#59; and 2&#41; they provided information or expressed an opinion on the financing process of SYSADOAs drugs in Spain&#46; In order to establish the position of the articles included on the financing of SYSADOAs by the SNS&#44; these were classified into the following 3 categories&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">A&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Partial and in favour&#46; When the content of the article offers information and arguments exclusively in favour of financing without providing information on contrary positions&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">B&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Impartial&#46; When the content of the article expresses positions and information both in favour of and against funding from different points of view&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">C&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Partial and against&#46; When the content of the article contains information and arguments exclusively against funding&#44; without providing information on positions in favour&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">In relation to social networks&#44; a search was designed for Twitter&#174; by compiling tweets related to the use and financing of SYSADOAs in Spain&#46; To do this&#44; an account was created for this purpose and the advanced search tool of the application itself was used&#46; The same keywords as those used in the press were applied as well as the same temporary filter&#46; In relation to the information provided by non-profit public bodies&#44; we included posts from associations&#44; foundations and public organisations figuring in the census by either the Spanish Ministry of the Interior or the Ministry of Justice&#46; Likewise&#44; for these posts&#44; the same inclusion criteria were maintained&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The search through the newspaper archives and records of the generalist media examined identified 46 potential articles&#46; Following the rejection of duplicate articles using the <span class="elsevierStyleItalic">MyNews tool&#44;</span> thirty-six articles were analysed for inclusion&#46; Finally&#44; a total of 15 articles that met the established inclusion criteria were accepted&#46; These articles had been published between the 1st of January 2018 and the 1st of January 2023&#46; Regarding the particular sources&#44; 5 articles were published in <span class="elsevierStyleItalic">La Vanguardia</span>&#44; 5 in <span class="elsevierStyleItalic">20minutos</span>&#44; 3 in <span class="elsevierStyleItalic">ABC</span>&#44; 1 in <span class="elsevierStyleItalic">El Pa&#237;s</span> and 1 in <span class="elsevierStyleItalic">El Mundo</span>&#46; The articles included in this study were described and summarised according to the media outlet where they were published&#59; the title&#59; the sources used&#59; and the content &#40;whether or not they recommended the use of SYSADOAs in OA&#44; and the position on funding by the Spanish NHS&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; It was observed that two-thirds of the articles included were published in <span class="elsevierStyleItalic">La Vanguardia</span> and <span class="elsevierStyleItalic">20minutos</span>&#44; in the same proportion&#46; Regarding the sources used by the articles&#44; 64&#37; were health professionals specialising in the field&#44; of which all belonged to the professional category of medicine&#46; Among the profiles of medical specialisation found&#44; the most frequent specialty was pharmacology &#40;43&#46;7&#37;&#41;&#44; followed by rheumatology &#40;25&#37;&#41;&#46; On the other hand&#44; the public bodies most consulted as a source were&#58; 24&#37; the OAFI&#59; 16&#37; the Spanish Association with Osteoporosis and Osteoarthritis &#40;AECOSAR&#41;&#44; 16&#37; the Ministry of Health&#59; 4&#37; the Spanish Patients&#39; Forum &#40;FEP&#41;&#59; 4&#37; the Spanish Society of Pharmacology &#40;SEF&#41; and 4&#37; the Spanish Society of Rheumatology &#40;SER&#41;&#46; Only 2 of the articles included used previously published scientific studies as their main reference&#46; The first scientific article cited was the <span class="elsevierStyleItalic">ArtRoCad</span> study&#44; which was used to recommend the use of SYSADOAs on the basis that only 5&#37; of the cost of treating osteoarthritis in Spain corresponded to these drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The second study cited was a report prepared by the Ministry of Health in 2014 through the Spanish Network of Agencies for the Assessment of Technologies and Services under the National Health System &#40;RedETS&#41; and the Basque Country&#8217;s regional Department of Health&#44; which concluded that international recommendations based on the available scientific evidence justify the process of divestment and the non-recommendation of the use of SYSADOAs in the treatment of OA in hip and knee&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Finally&#44; a systematic review and meta-analysis carried out by the <span class="elsevierStyleItalic">European Alliance of Associations for Rheumatology</span> &#40;EULAR&#41;&#44; which included 24 reviews and 150 articles&#44; concluded that GS supplementation presented low&#47;moderate evidence with little impact on pain and functional capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In relation to the position of articles included in the media on the use and financing of SYSADOA&#44; 73&#46;3&#37; recommended its use&#59; 20&#37; recommended its use&#44; albeit warning of the moderate degree of evidence&#44; little effect&#44; and as a therapeutic alternative&#59; while one article &#40;6&#46;6&#37;&#41; did not recommend its use due to the lack of scientific evidence&#46; Regarding funding&#44; 40&#37; of the articles were classified as partial and in favour &#40;3 in <span class="elsevierStyleItalic">La Vanguardia</span>&#44; 2 in <span class="elsevierStyleItalic">20minutos</span> and one in <span class="elsevierStyleItalic">ABC</span>&#41; and 33&#46;3&#37; as impartial &#40;2 in <span class="elsevierStyleItalic">ABC</span>&#44; one in <span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; one in <span class="elsevierStyleItalic">La Vanguardia</span> and one in <span class="elsevierStyleItalic">20minutos</span>&#41;&#46; A total of 26&#46;7&#37; of the articles &#40;2 in <span class="elsevierStyleItalic">20minutos</span>&#44; one in <span class="elsevierStyleItalic">El Mundo</span> and one in <span class="elsevierStyleItalic">La Vanguardia</span>&#41; did not provide information or describe positions on the financing of SYSADOA&#46; No article was identified that presented information exclusively against the financing of SYSADOAs by the NHS&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Through the search on the social network Twitter&#174;&#44; 1075 <span class="elsevierStyleItalic">tweets</span> were identified during the same period of inclusion as in the general media&#46; The information was recorded using the Microsoft Excel&#174; spreadsheet programme&#44; after eliminating duplicate <span class="elsevierStyleItalic">tweets</span>&#44; with advertising content and those made in a language other than Spanish&#44; thus leaving a total of 872 <span class="elsevierStyleItalic">tweets</span> obtained for analysis&#46; The <span class="elsevierStyleItalic">tweets</span> obtained by author&#44; date of post&#44; content of the message&#44; number of replies&#44; likes and <span class="elsevierStyleItalic">retweets</span> were analysed&#46; The annual distribution of <span class="elsevierStyleItalic">tweets</span> published and the number of global interactions can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; A total of 47&#46;9&#37; of tweets were published during 2020&#46; Due to the large number of posts&#44; the 5 accounts with the greatest activity and the most interactions were identified to facilitate the contextualization of the results &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The account with the highest activity was &#64;stopatrosis&#44; which accounted for 42&#46;6&#37; of the <span class="elsevierStyleItalic">tweets</span> obtained&#44; 4 times higher than the <span class="elsevierStyleItalic">tweets</span> published by the second most active account&#46; The &#64;stopatrosis profile does not identify anyone personally&#58; it defines itself as an account for the dissemination of OA prevention and the <span class="elsevierStyleItalic">tweets</span> are focussed on the use and vindication of SYSADOAs funding&#46; The &#64;consalud&#95;es account was the second most active account&#44; corresponding to one of the main online newspapers in the health sector&#58; Consalud&#46;es&#44; which belongs to Mediforum &#40;a business group whose main client is the pharmaceutical industry&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The third most active account was &#64;condronews&#44; an information account on news and research on OA&#44; belonging to Laboratorios Reig Jofre S&#46;A&#59; these laboratories manufacture SYSADOAs drugs&#44; among other products&#46; The fourth most active account was that of the user Carmen Arp&#243;n Dom&#237;nguez &#64;fabulosa1962&#44; a retired nurse from the Rioja Regional Health Service &#40;SERIS&#41;&#46; These 4 most active accounts shared messages in favour of SYSADOAs funding&#46; However&#44; the fifth most active account&#44; &#64;musicaypaz5011&#44; posted messages against the funding and use of SYSADOA&#46; This profile did not present any personal data on identification&#46; Subsequently&#44; this user was contacted by messaging and was asked if he&#47;she wanted to identify their public profile&#46; The user reported that their profession was that of a doctor&#44; without providing any more identification data or affiliation&#46; On the other hand&#44; the tweet with the greatest repercussion and impact was for funding&#44; arguing in favour of the economic expense being passed on to OA patients &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the communications by public bodies&#44; a total of 7 documents were identified&#46; We obtained 4 manifestos against defunding SYSADOA&#44; signed jointly by OAFI&#44; FEP&#44; AECOSAR&#44; the General Alliance of Patients &#40;AGP&#41;&#44; the Galician Rheumatology League &#40;LRG&#41;&#44; and Conarthritis&#46; In addition&#44; 2 communiqu&#233;s from the Ministry of Health responding to questions posed in the Senate by the Popular Party parliamentary group and a communiqu&#233; issued by the OAFI&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To facilitate the understanding and contextualization of the defunding process&#44; the results obtained were graphically synthesised and presented in the form of a timeline &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The objective of this study was to analyse the controversy over the use and financing of SYSADOAs in OA patients by Spain&#96;s SNS&#44; both in the general media and in social networks&#46; Together&#44; the main events and positions on this controversy by the most relevant public bodies and associations of patients and professionals were summarised chronologically&#46; To this end&#44; a total of 15 articles from media outlets from <span class="elsevierStyleItalic">ABC</span>&#44; <span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo</span>&#44; <span class="elsevierStyleItalic">La Vanguardia</span> and <span class="elsevierStyleItalic">20minutos</span> were analysed&#44; as well as 872 public <span class="elsevierStyleItalic">tweets</span> from the social network Twitter&#174; and 7 communiqu&#233;s from public bodies&#44; professional associations and scientific societies&#46; Regarding the results shown in the press articles analysed&#44; more than 90&#37; of the articles recommended the use of SYSADOA&#44; although 20&#37; of these referred to the controversy over its use due to the scientific evidence shown by these drugs and the limited use when there were no therapeutic alternatives&#46; This majority position recommending the use of SYSADOAs in the general media is far removed from the current discrepancy in the scientific community regarding their use in OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;17&#44;21&#44;24</span></a> The UK&#8217;s <span class="elsevierStyleItalic">National Institute for Health and Care Excellence</span> &#40;NICE&#41; clinical guideline on the management of OA did not recommend the use of SYSADOAs due to the scant evidence of GS&#44; CS&#44; and diacerein for this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Accordingly&#44; a few years earlier&#44; EULAR published a guideline with recommendations in which it considered the use of SYSADOAs to be a recommendation with low to moderate evidence&#44; with a moderate impact on pain and functional capacity in patients with OA of the hand&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> On the other hand&#44; a clinical guideline published in 2019 by the <span class="elsevierStyleItalic">European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis</span> &#40;ESCEO&#41; considered the use of SYSADOAs as a first line pharmacological treatment in patients with OA of the knee&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In relation to the sources used by the articles&#44; it should be noted that only 2 articles used references to scientific studies&#46; The scarce use of references to scientific studies as a source and the absence of contrast with the opposing parties may explain these results&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the position of the articles that we included against the financing of SYSADOAs by the SNS&#44; 40&#37; were in favour of funding&#46; No articles were identified against funding but only a third of all articles were considered impartial&#44; offering information and arguments both for and against&#46; We consider these results relevant in view of the major impact that the general press has on public opinion concerning health issues&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to the results obtained on the social network Twitter&#174;&#44; a similar trend towards support for SYSADOAs funding was observed&#46; Although the total number of tweets published in the last 5 years are mostly in favour&#44; 3 of the 5 accounts &#40;&#64;JuanGrvas&#44; &#64;je&#95;pala and &#64;ceciliacalpi&#41; with the most likes and <span class="elsevierStyleItalic">retweets</span> were against funding by the SNS&#46; This discrepancy can be explained if we look at the account with the most <span class="elsevierStyleItalic">tweets</span>&#44; likes and <span class="elsevierStyleItalic">retweets</span>&#58; &#64;stopartrosis&#59; which accounts for 42&#46;6&#37; of the total <span class="elsevierStyleItalic">tweets</span> included&#46; This is an anonymous account for circulation and support for the financing of SYSADOAs that publishes almost daily&#46; This account was contacted through messaging to obtain more information about this profile&#59; however&#44; no response was obtained&#46; After further investigation&#44; it was identified that this account also appears on social networks such as Facebook&#174; and initiated a signature collection initiative on the Change platform &#40;<a href="https://www.change.com/">https&#58;&#47;&#47;www&#46;change&#46;com&#47;</a>&#41; against defunding SYSADOAs &#40;2909 out of 5000 signatures&#44; in April 2023&#41;&#46; It is noteworthy that the second and third accounts with most posts &#40;&#64;consalud&#95;es and &#64;condronews&#41; were closely related to the pharmaceutical industry or represented laboratories that produce SYSADOAs drugs&#46; The existence of the great influence of marketing from the pharmaceutical industry on pharmaceutical prescriptions is well-known&#44; however the healthcare professionals who write the prescriptions tend to minimise its influence&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Despite this&#44; marketing and the influence exerted by the pharmaceutical industry must be considered in the financing process as one more player to be taken into account in the development&#44; advertising&#44; profitability and sustainability of SYSADOA drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">As regards the communiqu&#233;s from public bodies&#44; the main positions of public bodies and companies on the de&#47;financing process have been described&#46; Through the information obtained&#44; we can define 2 large blocks&#58; on the one hand&#44; the Ministry of Health&#44; which has maintained the position of defunding this group of drugs&#44; justified by scientific evidence on their low efficacy and the fact that they are drugs which can be directly advertised to the public in the EU&#46; In particular&#44; SYSADOAs are considered dietary supplements in the United States and other European countries and are not subject to public funding&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> On the other hand&#44; we have the second block led by the OAFI and other associations &#40;FEP&#44; AECOSAR&#44; AGP&#44; LRG and Conarthritis&#41; in favour of maintaining funding&#46; Together with the latest statement from the OAFI of 18th February 2022&#44; it was reported that the file on the de-funding of SYSADOAs pharmaceuticals had been closed following the appeal lodged&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The use of SYSADOAs for patients with OA continues to raise controversy in the scientific community&#59; the disparity of results in different systematic reviews and meta-analyses&#44; together with the discrepancies in recommendation between leading international clinical guidelines&#44; maintain a state of controversy among health professionals as to their degree of recommendation&#46; However&#44; in the face of this controversy in the literature&#44; there is consensus between foundations and associations of OA patients in Spain which&#44; together with some scientific societies&#44; maintain a position in favour of public funding and the use of SYSADOAs as a pharmacological treatment in patients with OA&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The debate that has arisen since the attempt by the Spanish Ministry of Health to defund these drugs in 2019&#44; until the case was closed due to an appeal being filed in 2022 by the OAFI&#44; has continued to be covered extensively by the general media&#46; The media have maintained a general trend of bias in favour of public funding of these drugs&#44; with foundations&#44; associations&#44; or professionals mostly being used&#44; to a certain extent&#44; as a source of information in favour of the use and funding of SYSADOA&#46; The media exerts a major influence on the population&#39;s view of public health issues&#44; as well as serving as a possible tool for large corporations to achieve their objectives and stimulate the demand for products that are sometimes unnecessary for the improvement of health&#46; That is why we consider these results relevant and propose a reflection on health communication models that would enable commercial interests to coexist alongside promoting the values of good health&#46; At the same time&#44; on the social network Twitter&#174;&#44; a large proportion of the posts have marked this trend in favour of funding&#44; partly by accounts related to the pharmaceutical industry&#44; while other dissenting users with fewer posts have presented a higher degree of interactions&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The patient organisations&#44; societies and foundations led by the OAFI have managed to halt the SYSADOAs defunding case opened by the DGCCSyF&#44; under the Spanish Ministry of Health&#46; We consider relevant the coverage by the media and social networks in this process&#44; as regards the mediatisation of this scientific&#47;social debate&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study has not received any external funding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of any kind&#46;</p></span></span>"
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    "fechaRecibido" => "2024-01-29"
    "fechaAceptado" => "2024-05-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1892465"
          "palabras" => array:6 [
            0 => "Osteoarthritis"
            1 => "Glucosamine"
            2 => "Chondroitin sulfate"
            3 => "Treatment"
            4 => "Social media"
            5 => "Health communication"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1892464"
          "palabras" => array:6 [
            0 => "Osteoartritis"
            1 => "Glucosamina"
            2 => "Condroit&#237;n sulfato"
            3 => "Tratamiento"
            4 => "Medios de comunicaci&#243;n sociales"
            5 => "Comunicaci&#243;n en salud"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The use of SYmptomatic Slow-Acting Drugs for Osteoarthritis &#40;SYSADOA&#41; in the treatment of osteoarthritis &#40;OA&#41; has been a topic of debate in the scientific community and public entities regarding their public financing in Spain&#46; The objective of this study was to describe and analyse the main positions of media outlets&#44; public entities&#44; regarding the use and financing of SYSADOA in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A qualitative and quantitative analysis of the content regarding the use and financing of SYSADOA was conducted in general media outlets &#40;<span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo&#44; La Vanguardia&#44; ABC&#44;</span> and <span class="elsevierStyleItalic">20minutos</span>&#41;&#44; public statements&#44; and Twitter publications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 15 articles in general media outlets&#44; 872 tweets&#44; and 7 public entity statements were identified&#46; Mostly&#44; media outlets &#40;91&#37;&#41; and social media platforms &#40;78&#37;&#41; exhibited a favorable trend towards funding&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion and conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The use of SYSADOA in OA patients continues to be controversial in the scientific community&#46; However&#44; there is consensus among patient associations in favour of public funding and use as a treatment for OA patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Discussion and conclusions"
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      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El uso los SYSADOA &#40;<span class="elsevierStyleItalic">SYmptomatic Slow-Acting Drugs for Osteoarthritis</span>&#41; en el tratamiento de la osteoartritis &#40;OA&#41; ha sido fuente de debate en la comunidad cient&#237;fica y en entidades p&#250;blicas con relaci&#243;n a su financiaci&#243;n p&#250;blica en Espa&#241;a&#46; El objetivo principal de este estudio fue describir y analizar las principales posiciones de medios de comunicaci&#243;n y entidades p&#250;blicas frente al uso y financiaci&#243;n de SYSADOA en Espa&#241;a&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un an&#225;lisis cualitativo y cuantitativo del contenido respecto al uso y financiaci&#243;n de SYSADOA en medios generalistas &#40;<span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo</span>&#44; <span class="elsevierStyleItalic">La Vanguardia</span>&#44; <span class="elsevierStyleItalic">ABC</span> y <span class="elsevierStyleItalic">20minutos</span>&#41;&#44; comunicados de organismos p&#250;blicos y publicaciones en Twitter&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 15 art&#237;culos en medios generalistas&#44; 872 tweets y 7 comunicados de organismos p&#250;blicos&#46; Mayoritariamente&#44; los datos obtenidos en medios de comunicaci&#243;n &#40;91&#37;&#41; y redes sociales &#40;78&#37;&#41; respaldaron la financiaci&#243;n de SYSADOA&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusi&#243;n y conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A pesar de la controversia en la comunidad cient&#237;fica&#44; este estudio destaca un consenso en los medios de comunicaci&#243;n y asociaciones a favor de la financiaci&#243;n p&#250;blica de SYSADOA en pacientes de OA&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Discusi&#243;n y conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:20 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1417
            "Ancho" => 2350
            "Tamanyo" => 174276
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
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            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of tweets and interactions per year obtained on Twitter&#174;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1008
            "Ancho" => 2107
            "Tamanyo" => 191978
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
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            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tweets with the most <span class="elsevierStyleItalic">retweets</span> and likes on Twitter&#174;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 692
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            "identificador" => "at0015"
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            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Timeline of the SYSADOA financing process in Spain&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Article Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Financing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">El Pa&#237;s</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#34;Ministry of Health to stop financing drugs for osteoarthritis&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carmen S&#225;nchez &#40;treasurer of the Spanish Association with Osteoporosis and Osteoarthritis &#91;AECOSAR&#93;&#41;Francisco Blanco Garc&#237;a &#40;Rheumatologist&#41;2 scientific articles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">The World</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis&#44; the disease suffered by Mario Vaquerizo and 7 million other Spaniards&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marcos Paulino &#40;Rheumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate evidence&#44; controversial use of SYSADOAs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">La Vanguardia</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health to stop funding SYSADOA DRUGS for patients with osteoarthritis&#58; &#34;Their scientific evidence is controversial&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of HealthJosep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Using SYSADOA to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis patients ask that sysadoas not be stopped from funding&#58; &#34;They are our only alternative&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;Mar&#237;a Antonia Robles &#40;President of AECOSAR&#41;Jos&#233; Luis Baquero &#40;Director of the Spanish Patients&#8217; Forum&#58; FEP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their efficacy&#44; safety&#44; and no available pharmacological alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Experts defend the use of SYSADOA drugs within the first line of treatment for osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antonio Garc&#237;a &#40;Professor of Pharmacology&#41;Mar&#237;a Teresa Tejerina &#40;President of the Spanish Society of Pharmacology&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alternatives to treat knee osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iv&#225;n Robert Calvet &#40;Traumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Does not recommend the use of SYSADOAs&#44; due to lack of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Those affected by osteoarthritis ask for more research for this neglected disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proper Use of SYSADOAs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ABC</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis&#58; &#34;I&#39;m terrified of people shaking my hand&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jos&#233; Luis Pablos &#40;Rheumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited use of SYSADOA&#44; ineffective&#44; only when there is no therapeutic alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Impartial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with osteoarthritis ask that a group of drugs not be stopped&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mar&#237;a Antonia Robles &#40;President of AECOSAR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOA&#44; especially for its high security against comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Health will stop financing a group of drugs against osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of HealthJosep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOA due to its effectiveness and safety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">20minutos</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protests by patients with osteoarthritis after the decision by the Health Ministry to stop financing a type of medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health&#44; Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their safety and effectiveness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">How diet influences the advance of osteoarthritis and rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A scientific article&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate evidence for the use of SYSADOAs&#44; with little benefit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis or arthritis&#44; do you know how to differentiate them&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mercedes Borja &#40;Journalist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Using SYSADOAs as cartilage protectors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The vulnerability of patients with osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carmen S&#225;nchez &#40;Treasurer of the Spanish Association with Osteoporosis and Osteoarthritis&#41;&#44; SocietySpanish Degree in Rheumatology&#44;Sergio Gim&#233;nez &#40;Primary Care Physician&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their efficacy&#44; safety&#44; and no available pharmacological alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health to stop funding SYSADOA DRUGS for osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verges &#40;Pharmacologist and CEO of OAFI&#41;Ministry of Health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their effectiveness and safety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Most active users</th><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#93;Users with the most <span class="elsevierStyleItalic">retweets</span></th><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Retweets</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Users with most engagement</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I like it&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230581"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;StopArtrosis&#64;StopArtrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">372&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230582"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;StopArtrosis&#64;StopArtrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230583"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#35;StopArtrosis&#64;StopArtrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230584"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ConSalud&#46;es&#64;Consalud&#95;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230585"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rose&#64;RosaMar6254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">374&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230586"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rose&#64;RosaMar6254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230587"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Condronews&#64;condronews&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230588"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jes&#250;s Palacio&#64;je&#95;pala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><elsevierMultimedia ident="202410110607230589"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jes&#250;s Palacio&#64;je&#95;pala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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Original Article
Controversy about the use and financing of SYSADOA for osteoarthritis in Spain: An analysis of the scientific-social debate in the media
Controversia en el uso y en la financiación de SYSADOA para la osteoartritis en España: un análisis del debate científico-social en los medios de comunicación
Pedro Alfonso Domínguez Veraa,b,c,
Corresponding author
peddomver@alum.us.es

Corresponding author.
, Luis Carrasco Páezc
a Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
b Servicio de Medicina Física Rehabilitación y Reumatología, Hospital Universitario Punta de Europa, Cádiz, Spain
c Departamento de Educación Física y Educación, Facultad de Educación, Universidad de Sevilla, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Osteoarthritis &#40;OA&#41; is one of the most common rheumatic diseases in the adult population over 45 years of age&#44; affecting more than 500 million people worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> OA is characterised by changes in joint metabolism&#44; affecting both the deterioration of hyaline cartilage and all the other components of the joint&#46; This can lead to the development of joint pain&#44; stiffness&#44; inflammation and disability&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> According to the EPISER 2016 prevalence study&#44; 29&#46;35&#37; of the adult population in Spain suffers from osteoarthritis in one or more joints&#44; this being more prevalent in women&#44; and the lumbar spine being the most affected joint&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> OA is considered the third leading cause of years lived with disability and entails high socioeconomic costs for health systems&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In Spain&#44; it is estimated that the total cost of hip and knee OA is between 1 and 2&#46;5&#37; of GDP&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The treatment of OA is a challenge for health professionals&#44; since there is no cure for the disease&#46; Current treatments focus on non-pharmacological&#44; pharmacological and surgical approaches&#44; the latter being recommended when conservative treatment is ineffective and where there is a major impact on quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this direction&#44; the use of a group of drugs known as SYSADOAs &#40;<span class="elsevierStyleItalic">SYmptomatic Slow-Acting Drugs for Osteoarthritis</span>&#41; has been proposed as a therapy option for the treatment of pain&#44; stiffness and functional capacity in OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; although there is widespread use in Spain of SYSADOAs drugs such as glucosamine &#40;GS&#41; and chondroitin sulphate &#40;CS&#41;&#44; their efficacy and safety have been the subject of controversy in the scientific literature in recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> On the one hand&#44; some studies have suggested that SYSADOAs may be effective in the treatment of OA&#44; especially in terms of reducing pain&#44; improving joint function&#44; and reducing the consumption of anti-inflammatory drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> On the other hand&#44; several systematic reviews have questioned the efficacy of SYSADOAs&#44; suggesting that they may have modest or no effects on pain and joint function&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> Due to the disparity in the results of clinical trials and meta-analyses in the use of GS and CS&#44; there is currently no consensus in the scientific evidence as to their efficacy in improving pain or functionality in people with OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to the scientific controversy surrounding the efficacy of SYSADOAs&#44; there is also a debate across the media over the financing of these treatments by the Spanish National Health System &#40;SNS in its Spanish acronym&#41;&#46; At the end of 2019&#44; the Directorate General for the Common Portfolio of SNS and Pharmacy Services &#40;DGCCSyF&#41;&#44; under the Ministry of Health&#44; began the processes of defunding these drugs&#46; Since then&#44; patient associations&#44; the Spanish Society of Health Professionals and civil society have all spoken out through the media&#44; creating a social debate&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In 2020&#44; OAFI &#40;International Osteoarthritis Foundation&#41; initiated legal proceedings with the lodging of an appeal against this de-financing move&#44; which was then temporarily paralysed&#46; Taking into account the importance of recommendations for effective and safe treatments for OA&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and the relevance of health-related information in the media&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> this study aims to qualitatively and quantitatively analyse the controversy over the use and financing of SYSADOAs drugs for OA patients in the Spanish mainstream media and social networks&#46; In addition&#44; another of its purposes is to describe the main positions of public bodies&#44; professional societies and patient organisations&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study was based&#44; on the one hand&#44; on the analysis of the content of articles published in the press&#44; posts in digital media&#44; statements from public bodies and posts on social networks from the 1st of January 2018 to the 1st of January 2023&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In relation to the search for articles in the press&#44; a search was carried out in the 5 generalist newspapers with the highest number of readers in Spain in 2021&#44; according to the General Media Study by the AIMC &#40;Spanish Association for Media Research&#44; 2021&#41;&#46; The search was run in both the digital and print versions of the 5 selected newspapers&#44; including the supplements of each newspaper&#46; To this end&#44; the search was undertaken through the MyNews tool&#44; a digital newspaper library belonging to the Spanish press&#46; The keywords used were &#34;osteoarthritis&#34;&#44; &#34;SYSADOA&#34;&#44; &#34;arthrosis&#34;&#44; &#34;treatment&#34;&#44; &#34;financing&#34; and &#34;drug&#34;&#44; in different combinations using the Boolean operators AND and OR&#46; Articles were included in the study if they met the following criteria&#58; 1&#41; they provided information in the title&#44; subtitle&#44; or body of the article concerning OA and the use of SYSADOAs in OA disease&#59; and 2&#41; they provided information or expressed an opinion on the financing process of SYSADOAs drugs in Spain&#46; In order to establish the position of the articles included on the financing of SYSADOAs by the SNS&#44; these were classified into the following 3 categories&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">A&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Partial and in favour&#46; When the content of the article offers information and arguments exclusively in favour of financing without providing information on contrary positions&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">B&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Impartial&#46; When the content of the article expresses positions and information both in favour of and against funding from different points of view&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">C&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Partial and against&#46; When the content of the article contains information and arguments exclusively against funding&#44; without providing information on positions in favour&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">In relation to social networks&#44; a search was designed for Twitter&#174; by compiling tweets related to the use and financing of SYSADOAs in Spain&#46; To do this&#44; an account was created for this purpose and the advanced search tool of the application itself was used&#46; The same keywords as those used in the press were applied as well as the same temporary filter&#46; In relation to the information provided by non-profit public bodies&#44; we included posts from associations&#44; foundations and public organisations figuring in the census by either the Spanish Ministry of the Interior or the Ministry of Justice&#46; Likewise&#44; for these posts&#44; the same inclusion criteria were maintained&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The search through the newspaper archives and records of the generalist media examined identified 46 potential articles&#46; Following the rejection of duplicate articles using the <span class="elsevierStyleItalic">MyNews tool&#44;</span> thirty-six articles were analysed for inclusion&#46; Finally&#44; a total of 15 articles that met the established inclusion criteria were accepted&#46; These articles had been published between the 1st of January 2018 and the 1st of January 2023&#46; Regarding the particular sources&#44; 5 articles were published in <span class="elsevierStyleItalic">La Vanguardia</span>&#44; 5 in <span class="elsevierStyleItalic">20minutos</span>&#44; 3 in <span class="elsevierStyleItalic">ABC</span>&#44; 1 in <span class="elsevierStyleItalic">El Pa&#237;s</span> and 1 in <span class="elsevierStyleItalic">El Mundo</span>&#46; The articles included in this study were described and summarised according to the media outlet where they were published&#59; the title&#59; the sources used&#59; and the content &#40;whether or not they recommended the use of SYSADOAs in OA&#44; and the position on funding by the Spanish NHS&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; It was observed that two-thirds of the articles included were published in <span class="elsevierStyleItalic">La Vanguardia</span> and <span class="elsevierStyleItalic">20minutos</span>&#44; in the same proportion&#46; Regarding the sources used by the articles&#44; 64&#37; were health professionals specialising in the field&#44; of which all belonged to the professional category of medicine&#46; Among the profiles of medical specialisation found&#44; the most frequent specialty was pharmacology &#40;43&#46;7&#37;&#41;&#44; followed by rheumatology &#40;25&#37;&#41;&#46; On the other hand&#44; the public bodies most consulted as a source were&#58; 24&#37; the OAFI&#59; 16&#37; the Spanish Association with Osteoporosis and Osteoarthritis &#40;AECOSAR&#41;&#44; 16&#37; the Ministry of Health&#59; 4&#37; the Spanish Patients&#39; Forum &#40;FEP&#41;&#59; 4&#37; the Spanish Society of Pharmacology &#40;SEF&#41; and 4&#37; the Spanish Society of Rheumatology &#40;SER&#41;&#46; Only 2 of the articles included used previously published scientific studies as their main reference&#46; The first scientific article cited was the <span class="elsevierStyleItalic">ArtRoCad</span> study&#44; which was used to recommend the use of SYSADOAs on the basis that only 5&#37; of the cost of treating osteoarthritis in Spain corresponded to these drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The second study cited was a report prepared by the Ministry of Health in 2014 through the Spanish Network of Agencies for the Assessment of Technologies and Services under the National Health System &#40;RedETS&#41; and the Basque Country&#8217;s regional Department of Health&#44; which concluded that international recommendations based on the available scientific evidence justify the process of divestment and the non-recommendation of the use of SYSADOAs in the treatment of OA in hip and knee&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Finally&#44; a systematic review and meta-analysis carried out by the <span class="elsevierStyleItalic">European Alliance of Associations for Rheumatology</span> &#40;EULAR&#41;&#44; which included 24 reviews and 150 articles&#44; concluded that GS supplementation presented low&#47;moderate evidence with little impact on pain and functional capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In relation to the position of articles included in the media on the use and financing of SYSADOA&#44; 73&#46;3&#37; recommended its use&#59; 20&#37; recommended its use&#44; albeit warning of the moderate degree of evidence&#44; little effect&#44; and as a therapeutic alternative&#59; while one article &#40;6&#46;6&#37;&#41; did not recommend its use due to the lack of scientific evidence&#46; Regarding funding&#44; 40&#37; of the articles were classified as partial and in favour &#40;3 in <span class="elsevierStyleItalic">La Vanguardia</span>&#44; 2 in <span class="elsevierStyleItalic">20minutos</span> and one in <span class="elsevierStyleItalic">ABC</span>&#41; and 33&#46;3&#37; as impartial &#40;2 in <span class="elsevierStyleItalic">ABC</span>&#44; one in <span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; one in <span class="elsevierStyleItalic">La Vanguardia</span> and one in <span class="elsevierStyleItalic">20minutos</span>&#41;&#46; A total of 26&#46;7&#37; of the articles &#40;2 in <span class="elsevierStyleItalic">20minutos</span>&#44; one in <span class="elsevierStyleItalic">El Mundo</span> and one in <span class="elsevierStyleItalic">La Vanguardia</span>&#41; did not provide information or describe positions on the financing of SYSADOA&#46; No article was identified that presented information exclusively against the financing of SYSADOAs by the NHS&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Through the search on the social network Twitter&#174;&#44; 1075 <span class="elsevierStyleItalic">tweets</span> were identified during the same period of inclusion as in the general media&#46; The information was recorded using the Microsoft Excel&#174; spreadsheet programme&#44; after eliminating duplicate <span class="elsevierStyleItalic">tweets</span>&#44; with advertising content and those made in a language other than Spanish&#44; thus leaving a total of 872 <span class="elsevierStyleItalic">tweets</span> obtained for analysis&#46; The <span class="elsevierStyleItalic">tweets</span> obtained by author&#44; date of post&#44; content of the message&#44; number of replies&#44; likes and <span class="elsevierStyleItalic">retweets</span> were analysed&#46; The annual distribution of <span class="elsevierStyleItalic">tweets</span> published and the number of global interactions can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; A total of 47&#46;9&#37; of tweets were published during 2020&#46; Due to the large number of posts&#44; the 5 accounts with the greatest activity and the most interactions were identified to facilitate the contextualization of the results &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The account with the highest activity was &#64;stopatrosis&#44; which accounted for 42&#46;6&#37; of the <span class="elsevierStyleItalic">tweets</span> obtained&#44; 4 times higher than the <span class="elsevierStyleItalic">tweets</span> published by the second most active account&#46; The &#64;stopatrosis profile does not identify anyone personally&#58; it defines itself as an account for the dissemination of OA prevention and the <span class="elsevierStyleItalic">tweets</span> are focussed on the use and vindication of SYSADOAs funding&#46; The &#64;consalud&#95;es account was the second most active account&#44; corresponding to one of the main online newspapers in the health sector&#58; Consalud&#46;es&#44; which belongs to Mediforum &#40;a business group whose main client is the pharmaceutical industry&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> The third most active account was &#64;condronews&#44; an information account on news and research on OA&#44; belonging to Laboratorios Reig Jofre S&#46;A&#59; these laboratories manufacture SYSADOAs drugs&#44; among other products&#46; The fourth most active account was that of the user Carmen Arp&#243;n Dom&#237;nguez &#64;fabulosa1962&#44; a retired nurse from the Rioja Regional Health Service &#40;SERIS&#41;&#46; These 4 most active accounts shared messages in favour of SYSADOAs funding&#46; However&#44; the fifth most active account&#44; &#64;musicaypaz5011&#44; posted messages against the funding and use of SYSADOA&#46; This profile did not present any personal data on identification&#46; Subsequently&#44; this user was contacted by messaging and was asked if he&#47;she wanted to identify their public profile&#46; The user reported that their profession was that of a doctor&#44; without providing any more identification data or affiliation&#46; On the other hand&#44; the tweet with the greatest repercussion and impact was for funding&#44; arguing in favour of the economic expense being passed on to OA patients &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the communications by public bodies&#44; a total of 7 documents were identified&#46; We obtained 4 manifestos against defunding SYSADOA&#44; signed jointly by OAFI&#44; FEP&#44; AECOSAR&#44; the General Alliance of Patients &#40;AGP&#41;&#44; the Galician Rheumatology League &#40;LRG&#41;&#44; and Conarthritis&#46; In addition&#44; 2 communiqu&#233;s from the Ministry of Health responding to questions posed in the Senate by the Popular Party parliamentary group and a communiqu&#233; issued by the OAFI&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To facilitate the understanding and contextualization of the defunding process&#44; the results obtained were graphically synthesised and presented in the form of a timeline &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The objective of this study was to analyse the controversy over the use and financing of SYSADOAs in OA patients by Spain&#96;s SNS&#44; both in the general media and in social networks&#46; Together&#44; the main events and positions on this controversy by the most relevant public bodies and associations of patients and professionals were summarised chronologically&#46; To this end&#44; a total of 15 articles from media outlets from <span class="elsevierStyleItalic">ABC</span>&#44; <span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo</span>&#44; <span class="elsevierStyleItalic">La Vanguardia</span> and <span class="elsevierStyleItalic">20minutos</span> were analysed&#44; as well as 872 public <span class="elsevierStyleItalic">tweets</span> from the social network Twitter&#174; and 7 communiqu&#233;s from public bodies&#44; professional associations and scientific societies&#46; Regarding the results shown in the press articles analysed&#44; more than 90&#37; of the articles recommended the use of SYSADOA&#44; although 20&#37; of these referred to the controversy over its use due to the scientific evidence shown by these drugs and the limited use when there were no therapeutic alternatives&#46; This majority position recommending the use of SYSADOAs in the general media is far removed from the current discrepancy in the scientific community regarding their use in OA&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;17&#44;21&#44;24</span></a> The UK&#8217;s <span class="elsevierStyleItalic">National Institute for Health and Care Excellence</span> &#40;NICE&#41; clinical guideline on the management of OA did not recommend the use of SYSADOAs due to the scant evidence of GS&#44; CS&#44; and diacerein for this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Accordingly&#44; a few years earlier&#44; EULAR published a guideline with recommendations in which it considered the use of SYSADOAs to be a recommendation with low to moderate evidence&#44; with a moderate impact on pain and functional capacity in patients with OA of the hand&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> On the other hand&#44; a clinical guideline published in 2019 by the <span class="elsevierStyleItalic">European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis</span> &#40;ESCEO&#41; considered the use of SYSADOAs as a first line pharmacological treatment in patients with OA of the knee&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In relation to the sources used by the articles&#44; it should be noted that only 2 articles used references to scientific studies&#46; The scarce use of references to scientific studies as a source and the absence of contrast with the opposing parties may explain these results&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the position of the articles that we included against the financing of SYSADOAs by the SNS&#44; 40&#37; were in favour of funding&#46; No articles were identified against funding but only a third of all articles were considered impartial&#44; offering information and arguments both for and against&#46; We consider these results relevant in view of the major impact that the general press has on public opinion concerning health issues&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to the results obtained on the social network Twitter&#174;&#44; a similar trend towards support for SYSADOAs funding was observed&#46; Although the total number of tweets published in the last 5 years are mostly in favour&#44; 3 of the 5 accounts &#40;&#64;JuanGrvas&#44; &#64;je&#95;pala and &#64;ceciliacalpi&#41; with the most likes and <span class="elsevierStyleItalic">retweets</span> were against funding by the SNS&#46; This discrepancy can be explained if we look at the account with the most <span class="elsevierStyleItalic">tweets</span>&#44; likes and <span class="elsevierStyleItalic">retweets</span>&#58; &#64;stopartrosis&#59; which accounts for 42&#46;6&#37; of the total <span class="elsevierStyleItalic">tweets</span> included&#46; This is an anonymous account for circulation and support for the financing of SYSADOAs that publishes almost daily&#46; This account was contacted through messaging to obtain more information about this profile&#59; however&#44; no response was obtained&#46; After further investigation&#44; it was identified that this account also appears on social networks such as Facebook&#174; and initiated a signature collection initiative on the Change platform &#40;<a href="https://www.change.com/">https&#58;&#47;&#47;www&#46;change&#46;com&#47;</a>&#41; against defunding SYSADOAs &#40;2909 out of 5000 signatures&#44; in April 2023&#41;&#46; It is noteworthy that the second and third accounts with most posts &#40;&#64;consalud&#95;es and &#64;condronews&#41; were closely related to the pharmaceutical industry or represented laboratories that produce SYSADOAs drugs&#46; The existence of the great influence of marketing from the pharmaceutical industry on pharmaceutical prescriptions is well-known&#44; however the healthcare professionals who write the prescriptions tend to minimise its influence&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Despite this&#44; marketing and the influence exerted by the pharmaceutical industry must be considered in the financing process as one more player to be taken into account in the development&#44; advertising&#44; profitability and sustainability of SYSADOA drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">As regards the communiqu&#233;s from public bodies&#44; the main positions of public bodies and companies on the de&#47;financing process have been described&#46; Through the information obtained&#44; we can define 2 large blocks&#58; on the one hand&#44; the Ministry of Health&#44; which has maintained the position of defunding this group of drugs&#44; justified by scientific evidence on their low efficacy and the fact that they are drugs which can be directly advertised to the public in the EU&#46; In particular&#44; SYSADOAs are considered dietary supplements in the United States and other European countries and are not subject to public funding&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> On the other hand&#44; we have the second block led by the OAFI and other associations &#40;FEP&#44; AECOSAR&#44; AGP&#44; LRG and Conarthritis&#41; in favour of maintaining funding&#46; Together with the latest statement from the OAFI of 18th February 2022&#44; it was reported that the file on the de-funding of SYSADOAs pharmaceuticals had been closed following the appeal lodged&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">The use of SYSADOAs for patients with OA continues to raise controversy in the scientific community&#59; the disparity of results in different systematic reviews and meta-analyses&#44; together with the discrepancies in recommendation between leading international clinical guidelines&#44; maintain a state of controversy among health professionals as to their degree of recommendation&#46; However&#44; in the face of this controversy in the literature&#44; there is consensus between foundations and associations of OA patients in Spain which&#44; together with some scientific societies&#44; maintain a position in favour of public funding and the use of SYSADOAs as a pharmacological treatment in patients with OA&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The debate that has arisen since the attempt by the Spanish Ministry of Health to defund these drugs in 2019&#44; until the case was closed due to an appeal being filed in 2022 by the OAFI&#44; has continued to be covered extensively by the general media&#46; The media have maintained a general trend of bias in favour of public funding of these drugs&#44; with foundations&#44; associations&#44; or professionals mostly being used&#44; to a certain extent&#44; as a source of information in favour of the use and funding of SYSADOA&#46; The media exerts a major influence on the population&#39;s view of public health issues&#44; as well as serving as a possible tool for large corporations to achieve their objectives and stimulate the demand for products that are sometimes unnecessary for the improvement of health&#46; That is why we consider these results relevant and propose a reflection on health communication models that would enable commercial interests to coexist alongside promoting the values of good health&#46; At the same time&#44; on the social network Twitter&#174;&#44; a large proportion of the posts have marked this trend in favour of funding&#44; partly by accounts related to the pharmaceutical industry&#44; while other dissenting users with fewer posts have presented a higher degree of interactions&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The patient organisations&#44; societies and foundations led by the OAFI have managed to halt the SYSADOAs defunding case opened by the DGCCSyF&#44; under the Spanish Ministry of Health&#46; We consider relevant the coverage by the media and social networks in this process&#44; as regards the mediatisation of this scientific&#47;social debate&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study has not received any external funding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of any kind&#46;</p></span></span>"
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          "titulo" => "Methodology"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflict of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2024-01-29"
    "fechaAceptado" => "2024-05-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1892465"
          "palabras" => array:6 [
            0 => "Osteoarthritis"
            1 => "Glucosamine"
            2 => "Chondroitin sulfate"
            3 => "Treatment"
            4 => "Social media"
            5 => "Health communication"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1892464"
          "palabras" => array:6 [
            0 => "Osteoartritis"
            1 => "Glucosamina"
            2 => "Condroit&#237;n sulfato"
            3 => "Tratamiento"
            4 => "Medios de comunicaci&#243;n sociales"
            5 => "Comunicaci&#243;n en salud"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The use of SYmptomatic Slow-Acting Drugs for Osteoarthritis &#40;SYSADOA&#41; in the treatment of osteoarthritis &#40;OA&#41; has been a topic of debate in the scientific community and public entities regarding their public financing in Spain&#46; The objective of this study was to describe and analyse the main positions of media outlets&#44; public entities&#44; regarding the use and financing of SYSADOA in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A qualitative and quantitative analysis of the content regarding the use and financing of SYSADOA was conducted in general media outlets &#40;<span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo&#44; La Vanguardia&#44; ABC&#44;</span> and <span class="elsevierStyleItalic">20minutos</span>&#41;&#44; public statements&#44; and Twitter publications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 15 articles in general media outlets&#44; 872 tweets&#44; and 7 public entity statements were identified&#46; Mostly&#44; media outlets &#40;91&#37;&#41; and social media platforms &#40;78&#37;&#41; exhibited a favorable trend towards funding&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion and conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The use of SYSADOA in OA patients continues to be controversial in the scientific community&#46; However&#44; there is consensus among patient associations in favour of public funding and use as a treatment for OA patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Discussion and conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El uso los SYSADOA &#40;<span class="elsevierStyleItalic">SYmptomatic Slow-Acting Drugs for Osteoarthritis</span>&#41; en el tratamiento de la osteoartritis &#40;OA&#41; ha sido fuente de debate en la comunidad cient&#237;fica y en entidades p&#250;blicas con relaci&#243;n a su financiaci&#243;n p&#250;blica en Espa&#241;a&#46; El objetivo principal de este estudio fue describir y analizar las principales posiciones de medios de comunicaci&#243;n y entidades p&#250;blicas frente al uso y financiaci&#243;n de SYSADOA en Espa&#241;a&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un an&#225;lisis cualitativo y cuantitativo del contenido respecto al uso y financiaci&#243;n de SYSADOA en medios generalistas &#40;<span class="elsevierStyleItalic">El Pa&#237;s</span>&#44; <span class="elsevierStyleItalic">El Mundo</span>&#44; <span class="elsevierStyleItalic">La Vanguardia</span>&#44; <span class="elsevierStyleItalic">ABC</span> y <span class="elsevierStyleItalic">20minutos</span>&#41;&#44; comunicados de organismos p&#250;blicos y publicaciones en Twitter&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 15 art&#237;culos en medios generalistas&#44; 872 tweets y 7 comunicados de organismos p&#250;blicos&#46; Mayoritariamente&#44; los datos obtenidos en medios de comunicaci&#243;n &#40;91&#37;&#41; y redes sociales &#40;78&#37;&#41; respaldaron la financiaci&#243;n de SYSADOA&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusi&#243;n y conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A pesar de la controversia en la comunidad cient&#237;fica&#44; este estudio destaca un consenso en los medios de comunicaci&#243;n y asociaciones a favor de la financiaci&#243;n p&#250;blica de SYSADOA en pacientes de OA&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Discusi&#243;n y conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:20 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1417
            "Ancho" => 2350
            "Tamanyo" => 174276
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of tweets and interactions per year obtained on Twitter&#174;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1008
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            "Tamanyo" => 191978
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tweets with the most <span class="elsevierStyleItalic">retweets</span> and likes on Twitter&#174;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 692
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
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            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Timeline of the SYSADOA financing process in Spain&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Article Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Financing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">El Pa&#237;s</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#34;Ministry of Health to stop financing drugs for osteoarthritis&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carmen S&#225;nchez &#40;treasurer of the Spanish Association with Osteoporosis and Osteoarthritis &#91;AECOSAR&#93;&#41;Francisco Blanco Garc&#237;a &#40;Rheumatologist&#41;2 scientific articles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">The World</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis&#44; the disease suffered by Mario Vaquerizo and 7 million other Spaniards&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marcos Paulino &#40;Rheumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate evidence&#44; controversial use of SYSADOAs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">La Vanguardia</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health to stop funding SYSADOA DRUGS for patients with osteoarthritis&#58; &#34;Their scientific evidence is controversial&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of HealthJosep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Using SYSADOA to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis patients ask that sysadoas not be stopped from funding&#58; &#34;They are our only alternative&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;Mar&#237;a Antonia Robles &#40;President of AECOSAR&#41;Jos&#233; Luis Baquero &#40;Director of the Spanish Patients&#8217; Forum&#58; FEP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their efficacy&#44; safety&#44; and no available pharmacological alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Experts defend the use of SYSADOA drugs within the first line of treatment for osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antonio Garc&#237;a &#40;Professor of Pharmacology&#41;Mar&#237;a Teresa Tejerina &#40;President of the Spanish Society of Pharmacology&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs to decrease pain and increase functional capacity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alternatives to treat knee osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iv&#225;n Robert Calvet &#40;Traumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Does not recommend the use of SYSADOAs&#44; due to lack of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Those affected by osteoarthritis ask for more research for this neglected disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proper Use of SYSADOAs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ABC</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis&#58; &#34;I&#39;m terrified of people shaking my hand&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jos&#233; Luis Pablos &#40;Rheumatologist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited use of SYSADOA&#44; ineffective&#44; only when there is no therapeutic alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Impartial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with osteoarthritis ask that a group of drugs not be stopped&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mar&#237;a Antonia Robles &#40;President of AECOSAR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOA&#44; especially for its high security against comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Health will stop financing a group of drugs against osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of HealthJosep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOA due to its effectiveness and safety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">20minutos</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Protests by patients with osteoarthritis after the decision by the Health Ministry to stop financing a type of medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health&#44; Josep Verg&#233;s &#40;Pharmacologist and CEO of OAFI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their safety and effectiveness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">How diet influences the advance of osteoarthritis and rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A scientific article&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate evidence for the use of SYSADOAs&#44; with little benefit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoarthritis or arthritis&#44; do you know how to differentiate them&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mercedes Borja &#40;Journalist&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Using SYSADOAs as cartilage protectors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8213;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The vulnerability of patients with osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carmen S&#225;nchez &#40;Treasurer of the Spanish Association with Osteoporosis and Osteoarthritis&#41;&#44; SocietySpanish Degree in Rheumatology&#44;Sergio Gim&#233;nez &#40;Primary Care Physician&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their efficacy&#44; safety&#44; and no available pharmacological alternative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ministry of Health to stop funding SYSADOA DRUGS for osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Josep Verges &#40;Pharmacologist and CEO of OAFI&#41;Ministry of Health&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of SYSADOAs due to their effectiveness and safety&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3686937.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Classification and summary of the content of articles identified in the general media&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULT