Management of knee osteoarthritis in primary care: pain and depression are the major obstacles

OBJECTIVES: Osteoarthritis (OA) management is a challenge, as OA consists of a spectrum of pathologies requiring a multifaceted treatment approach. Patient education programmes (PEP) are attractive, as they may be cost effective and potentially efficacious.The goals of the study were to determine what may hinder the efficacy of a PEP for knee OA by determining the relevance of depression, pain, disease knowledge and physical ability in patients to their response to a PEP. METHODS: Clinical and demographic data relating to 170 patients who completed a trial of a PEP were analysed to determine how they interrelate during patient management. RESULTS: All patients showed a progressive decrease in mental health over the duration of the study (P<.001). Greater pain was associated with reduced coping, increased depression and reduced physical ability (P<.05). Women were more likely to experience disability (P<.05). Disability was associated with reduced ability to cope, increased depression and the experience of more pain (P<.05). Subjects with a Caucasian background were significantly (P<.05) more likely to possess knowledge of OA than other ethnic groups. The lowest knowledge group experienced more pain; the highest knowledge group was coping better and had less depression (P<.05). CONCLUSION: A complex interrelationship between depression, pain, disease knowledge, and physical ability in patients with knee OA has been demonstrated. Specifically, the treatment of depression and pain may be paramount to the successful treatment of knee OA, and these factors should be considered in each patient and management priorities made.     

The effect of transcranial direct stimulation as an add-on treatment to conventional physical therapy on pain intensity and functional ability in individuals with knee osteoarthritis: A randomized controlled trial

ObjectiveTo investigate the effect of adding transcranial direct current stimulation (tDCS) to conventional physiotherapy treatment (PT) on pain and performance of individuals with knee osteoarthritis (KOA).MethodsEighty people suffering from chronic KOA participated in this study. They were randomly divided into four treatment groups, including PT combined with tDCS over the primary motor cortex (M1), PT combined with tDCS over the primary sensory cortex (S1), PT combined with tDCS over the dorsolateral prefrontal cortex (DLPFC), and PT combined with sham tDCS. A visual analog scale (VAS) for pain intensity, the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire for knee-related disability, and several performance tests (stepping 15 s, chair stand test in 30 s, and walking 4 × 10 m) were used for assessment following 10 sessions of tDCS (T1), and one month after the last session of tDCS (T2).ResultsDifferential effects on pain intensity, knee-related disability, and performance were found between groups. Compared to sham tDCS: (i) tDCS over M1 improved VAS pain score, KOOS disability score, and performance tests at T1 and T2; (ii) tDCS over S1 improved VAS pain score at T1 and T2 and KOOS disability score and performance tests at T2; (iii) tDCS over the DLPFC improved VAS pain score at T1 and performance tests at T1 and T2.ConclusiontDCS could be a beneficial add-on treatment to conventional PT for pain relief, disability reduction and functional improvement in patients with KOA.     

Repetitive transcranial magnetic stimulation may be superior to drug therapy in the treatment of Alzheimer's disease: A systematic review and Bayesian network meta-analysis

Background

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that is primarily used to treat a variety of neuropsychiatric conditions. Recently, previous research reports stated that rTMS have the characteristics of neurorestorative in Alzheimer's disease (AD). However, the relevant clinical research evidence has not been fully summarized.

Methods

This article performed a network meta-analysis of individual participant data from eligible studies searched in PubMed, Embase, and the Cochrane Library from inception to March 31, 2022. The drug treatments involved were acetylcholinesterase inhibitors (AChEIs), N-methyl-d -aspartate (NMDA), anti-amyloid-beta (Aβ), and some new targeted therapeutic drugs.

Results

A total of 15, 548 individuals with AD disease in 57 randomized clinical trials (RCTs) were included in this meta-analysis. The results indicated that the patients who received rTMS treatment (standard mean difference [SMD]: 0.65; 95% confidence interval [CI]: 0.22–1.07) had a better MMSE score than placebo. Treatment outcome analysis showed that, compared with multiple pharmacological interventions, rTMS acquired the greatest probability rank with the best cognitive improvement in MMSE score [the surface under the cumulative ranking curve (SUCRA) 93.3%] and ADAS-cog score (SUCRA 86.7%). At the same time, rTMS treatment had the lowest rank in the adverse events (SUCRA 24.1%) except for the placebo group (SUCRA 19.1%).

Conclusion

Compared with the current clinical drug treatment, rTMS demonstrated better cognitive function improvement and fewer adverse events in AD patients. Therefore, rTMS shows broad prospects in the treatment of Alzheimer's disease, and it is worth being widely popularized in clinic.