University of Oulu

Veronese, N., Cooper, C., Bruyère, O. et al. Multimodal Multidisciplinary Management of Patients with Moderate to Severe Pain in Knee Osteoarthritis: A Need to Meet Patient Expectations. Drugs 82, 1347–1355 (2022).

Multimodal multidisciplinary management of patients with moderate to severe pain in knee osteoarthritis : a need to meet patient expectations

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Author: Veronese, Nicola1; Cooper, Cyrus2; Bruyère, Olivier3;
Organizations: 1Geriatrics Section, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127 Palermo, Italy
2MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
3Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
4Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
5Department of Rheumatology, CHRC, NOVA Medical School, CHLO, EPE, Hospital Egas Moniz, Universidade Nova de Lisboa, Lisbon, Portugal
6Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Bât B35, 4000, Liège, Belgium
7Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
8Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
9Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
10Chair EULAR Study Group for Collaborative Research, Amsterdam, The Netherlands
11Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
12Head of Rheumatology Department, Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, 28040, Madrid, Spain
13WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
14Scientific Office, Austrian Medicines and Medical Devices Agency, Federal Office for Safety in Health Care, Vienna, Austria
15Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
16Clinic for Orthopedic Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
17Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
18Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, LT-08406, Vilnius, Lithuania
19Departments of Orthopedics, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
20Departments of Rheumatology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
21Departments of Clinical Immunology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
22Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
23Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, FI-90014, Oulu, Finland
24Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM) and Arthritis Division, University of Montreal Hospital Centre (CHUM), Montreal, Canada
25Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
26Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
27Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM U1124, Paris, France
28Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-11-18


Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.

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Series: Drugs
ISSN: 0012-6667
ISSN-E: 1179-1950
ISSN-L: 0012-6667
Volume: 82
Issue: 13
Pages: 1347 - 1355
DOI: 10.1007/s40265-022-01773-5
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by Università degli Studi di Palermo within the CRUI-CARE Agreement.
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