THE VAST MAJORITY OF OSTEOARTHRITIS PATIENTS ARE DISSATISFIED WITH THEIR CURRENT TREATMENT, AND DEMAND NON-PHARMACOLOGICAL TREATMENTS FOR THEIR CONDITION
Bio-optimised turmeric is a natural and innovative therapeutic option, which has clinically demonstrated a very high efficacy for the management of pain and joint inflammation in oral treatments. In the case of intra-articular treatments, hyaluronic acid becomes the ideal alternative with clinical evidence. This statement has been shown in the webinar “Improving the quality of life of patients with osteoarthritis, with an innovative, natural and effective therapeutic approach”.
Around 300 million of people suffer from osteoarthritis worldwide. In Spain, seven million are affected, which has a consequent impact on the health system. It is estimated that 20 percent of medical consultations in Spain are related to this disease, which has an average cost of 4,738 million euros per year. The most common patient profile for osteoarthritis is women between 60 and 79 years old.
“Osteoarthritis has a severe impact on patients’ lives due to the associated limitations, symptoms and comorbidities”. This was emphasised on September 16th in the webinar “Improving the quality of life of patients with osteoarthritis with an innovative, natural and effective therapeutic approach”, by Josep Vergés, head of the International Foundation of Osteoarthritis OAFI) and clinical pharmacologist with more than 25 years of experience in the management of this pathology.
The event was organised by the specialised women’s health laboratory, Procare Health, on the continuing medical education platform, Ginecare.
Joint pain and stiffness are the main symptoms described by patients with osteoarthritis (84.2% and 48.9%, respectively) that decreases their quality of life. In addition, 21% of them reported problems of sleep. These data, provided by Dr. Vergés, are based on the OAFI’s Global Osteoarthritis Patient Perception Survey (GOAPPS). The survey was conducted among 1,512 patients from six countries (Colombia, Spain, Italy, Mexico, the United States and Venezuela), This survey quantifies and qualifies the perception of their quality of life. It also highlighted the importance of health promotion and self-care strategies that address unhealthy weight and low levels of physical activity to improve health conditions.
In addition to physical discomfort, the GOAPPS also highlights the emotional aspects of people with osteoarthritis. “The patient feels misunderstood, isolated, anxious, dependent, lonely and depressed. They need a lot of affection, to be listened to, to be understood and to be helped to have a better quality of life,” explained Dr. Vergés.
According to the GOAPPS, the vast majority of osteoarthritis patients would like to have access to non-pharmacological/non-surgical treatments. Thus, the survey shows that 78 percent of the patients who were consulted, would like to have additional access to non-pharmacological treatments.
THERAPEUTIC APPROACH TO OSTEOARTHRITIS
Jordi Monfort, head of the Osteoarthritis Unit of the Rheumatology Service of the “Hospital del Mar in Barcelona”, who also participated in the webinar, explained the therapeutic management in the progression of the disease and discussed the current natural alternatives.
“Treatments for osteoarthritis have a dual purpose. On the one hand, to improve and prevent pain, and on the other to prevent the progression of the disease”, specified Jordi Monfort. The doctor reminded the audience of the dual strategy in the therapeutic approach to osteoarthritis: pharmacological treatment and non-pharmacological treatment.
Education, exercise, injury prevention, weight loss, orthotics, and dietary supplements are key non-pharmacological strategies in basic treatment, especially in the early stages of the disease, along with topical treatments (NSAIDs, capsaicin, lidocaine patches) and oral treatments (paracetamol, NSAIDs, SYSADOA, opioids and duloxetine). In more advanced stages of the pathology, intra-articular treatments (corticosteroids and hyaluronic acid) are used, while surgery is the last option, according to Dr. Monfort.
Regarding the consumption of NSAIDs, he stressed that their consumption in Spain is at 37 daily doses per thousand inhabitants, which is very high, and that it is therefore important to seek “sustainable therapeutic alternatives in terms of health” that produce the same benefits, but with fewer adverse effects, especially in the case of elderly, chronic and polymedicated patients. “There are new options to reduce the dose of these treatments, such as turmeric, which has shown beneficial effects on the pro-inflammatory cascade,” he added.
BIOPTIMIZED TURMERIC, A NATURAL OPTION
Turmeric is a herb extracted from the root of the Curcuma longa plant, which has been used for centuries in countries such as India and Japan for its antioxidant and anti-inflammatory properties. The problem is that turmeric is poorly absorbed by the body, for that reason, in order to achieve optimal anti-inflammatory activity it would be necessary to add very high amounts of turmeric to the diet.
Dr Jordi Monfort explained that the solution to increase absorption and availability in the body is bio-optimised turmeric, which can be found in products such as Dolocare Flex, a natural option for managing joint pain. Dolocare Flex uses a micro-emulsion of curcumin that is 1,350 times more available than that present in turmeric powder. One capsule is equivalent to ingesting 950 grams, almost a kilo of the turmeric powder you can buy in the supermarket.
Dolocare Flex is supported by numerous clinical studies. Dr Monfort cited a six-month retrospective observational study conducted in Belgium objectives were to evaluate the therapeutic potential of Dolocare Flex on joint function, determining the period of treatment required until the onset of clinical benefit, identifying adverse effects and assess the possible existence of differences in effect depending on the affected joint. The study showed a rapid and progressive decrease in pain and an increase in joint flexibility that improved the patient’s quality of life. It also showed a significant reduction in concomitant treatments and a similar analgesic effect in all joints, all with excellent tolerability.
Dr. Monfort also referred to the COPRA prospective multicenter study ith a randomized, double-blind, placebo-controlled design, it included 150 patients aged 45 to 80 years with moderate-severe knee osteoarthritis, regular users of paracetamol and/or NSAIDs for pain management., which was presented at the 2018 European League Against Rheumatism (EULAR) congress. Patients were evaluated on the first and third month of treatment with Dolocare Flex. In both periods, a significant reduction in pain and disease impact was observed versus the placebo group. Dolocare Flex was safe and well tolerated with no evidence of serious adverse effects.
HIALURONIC ACID, PERFECT FOR THE ARTHROSIS TREATMENT
In intra-articular treatments, corticosteroids are characterized by rapid but short-lasting pain relief, are useful in inflammatory flare-ups and have adverse effects and contraindications. The other option is hyaluronic acid, a natural macropolysaccharide synthesized by cartilage cells and the synovial membrane, which restores the viscoelastic properties of healthy synovial fluid; it is also anti-inflammatory and protective of pain receptors. According to Dr. Jordi Monfort, the ideal hyaluronic acid for the treatment of osteoarthritis should be of high concentration (to relieve pain more quickly and for longer), high density (to promote endogenous synthesis of hyaluronic acid), non-cross-linked (to provide greater safety) and obtained by bio-fermentation (to increase its tolerability).
The scientific evidence of hyaluronic acid can be verified in several studies, including the recently completed NO-Pain study, of which Dr. Monfort has been the coordinator. This is a multicenter, observational, prospective, non-comparative study that evaluated the clinical benefits of a single infiltration of high concentration and viscosity hyaluronic acid (Pronolis HD 2.5% Monoshot) in more than 150 patients with primary osteoarthritis of the knee.
Patients obtained rapid and significant reductions in pain and joint stiffness that were progressive during the 6 months of the study. A significant increase in functional capacity and quality of life was observed. In addition, safety was demonstrated with the absence of cases of synovitis and fibrosis during the study.
These results correlate with those previously obtained by Dr. Monfort himself in a pilot study with 10 patients. Overall, it can be extrapolated that patients treated with “Pronolis HD 2.5% Monoshot” obtain improvements in their symptomatology that extend beyond 12 months from the start of the treatment after a single injection.
GINECARE, CONTINUING MEDICAL FORMATION
This webinar was the fifth meeting that organized this year by Ginecare Continuing Medical Education; a platform that hosts continuing education for doctors, nurses, midwives and pharmacists. It has been presented and conducted by Dr. Juan Manuel Rios Ruh, traumatologist and professor at the Aware doctor platform, who has highlighted the importance of training spaces for health professionals in the context of the pandemic caused by COVID-19.