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Vol. 17. Issue 10.
Pages 595-600 (December 2021)
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Vol. 17. Issue 10.
Pages 595-600 (December 2021)
Original Article
Experts document about an adequate utilization of SYSADOAs in controversial clinical situations
Documento de expertos sobre el uso apropiado de los SYSADOA en situaciones clínicas controvertidas
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Jordi Monforta,
Corresponding author
JMonfort@parcdesalutmar.cat

Corresponding author.
, Xavier Carnéb, Benjamín Abarcac, Sergio Giménezd, Montserrat Romerae, Ingrid Möllerf, Marco Bibasg, Marianna Vitalonig, Aina Batlleh, Josep Vergésg
a Servicio de Reumatología, Parc de Salut Mar, Barcelona, Spain
b Exmiembro del Servicio de Farmacologia Clínica, Hospital Clínic, Barcelona, Spain
c Centro de Salud Sagrado Corazón, Lugo, Spain
d Centro de Salud El Limonar, Málaga, Spain
e Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
f Institut Poal de Reumatologia, Barcelona, Spain
g OAFI Foundation, Barcelona, Spain
h GOC Networking, Barcelona, Spain
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Abstract
Background and objective

SYSADOAs (Symptomatic Slow-Acting Drugs for Osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations.

Materials and methods

Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy.

Results

The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding Diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease.

Conclusions

There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use. This work may contribute towards improving the management protocols of SYSADOAs in the treatment of OA and offer a useful approach in uncertain situations.

Keywords:
Anti-inflammatory agents/therapeutic use
Chondroitin sulphate/therapeutic use
Glucosamine/therapeutic use
Diacerein
Consensus
Osteoarthritis/drug therapy
Resumen
Antecedentes y objetivo

Los SYSADOA (del inglés, Symptomatic Slow-Acting Drugs for OsteoArthritis) orales son compuestos naturales que han demostrado ser útiles y seguros en el tratamiento de la artrosis (AO). Sin embargo, su uso en ciertas situaciones clínicas carece aún de evidencia científica y recomendaciones claras. El objetivo de este trabajo fue conocer la opinión de un grupo de expertos sobre uso de los SYSADOA en el tratamiento de la AO en situaciones clínicas controvertidas.

Materiales y métodos

Siguiendo el método del uso apropiado mediante la técnica Delphi, se valoraron 206 consultas concretas, estructuradas en 24 preguntas clínicas. Un panel de expertos, compuesto por un total de 15 especialistas, respondió a las dos rondas de consulta a través de una plataforma online. Los resultados se analizaron y debatieron en una reunión presencial con los coordinadores y el comité científico. Según el porcentaje de panelistas que coincidieron en los mismos, se clasificaron los resultados en términos de unanimidad, consenso, mayoría y discrepancia.

Resultados

Se consensuaron los siguientes puntos: (1) el fenotipo del paciente condiciona el uso de los SYSADOA orales; (2) los SYSADOA orales se consideran adecuados en la AO primaria (rodilla, mano y cadera) y en algunos tipos de AO secundaria; no se consideran adecuados en AO erosiva de manos, hombro, columna y tobillo; (3) los SYSADOA orales pueden ser prescritos a pacientes con riesgo o enfermedad cardiovascular, enfermedad digestiva, hipertensión, dislipemia, enfermedad vascular periférica, diabetes tipo 2 y, a excepción de Diacereína, en pacientes con reflujo esofágico. No se obtuvo acuerdo en la prescripción de los SYSADOA orales en pacientes con enfermedad hepática y renal.

Conclusiones

Existe escasa literatura sobre el uso de los SYSADOA orales en el tratamiento de la AO en situaciones controvertidas. Mediante este trabajo se ha podido conocer el posicionamiento de un grupo de expertos frente a situaciones clínicas para las cuales no existe evidencia científica respecto a su uso. Este trabajo puede contribuir a mejorar los protocolos de manejo de los SYSADOA en el tratamiento de la AO y ser un instrumento útil en situaciones de incertidumbre.

Palabras clave:
Agentes antiinflamatorios/uso terapéutico
Condroitín sulfato/uso terapéutico
Glucosamina/uso terapéutico
Diacereína
Consenso
Artrosis/terapia farmacológica

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