title: Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system.
abstract: BACKGROUND
  Symptomatic slow-acting drugs (SYSADOA) have been largely studied over the last decade. The objective of this study is to prepare a document providing recommendations for the use of SYSADOA in osteoarthritis (OA).
  
  
  METHODS
  The following interventions were taken into consideration: avocado/soybean unsaponifiables, chondroitin sulfate, diacereine, glucosamine sulfate, hyaluronic acid, oral calcitonin, risedronate, strontium ranelate. Recommendations were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The GRADE system is based on a sequential assessment of the quality of evidence, followed by assessment of the balance between benefits versus downsides and subsequent judgment about the strength of recommendations.
  
  
  RESULTS
  Chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid have demonstrated pain reduction and physical function improvement with very low toxicity, with moderate to high quality evidence. Even if pre-clinical data and some preliminary in vivo studies have suggested that oral calcitonin and strontium ranelate could be of potential interest in OA, additional well-designed studies are needed.
  
  
  CONCLUSIONS
  In the benefit/risk ratio, the use of chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid could be of potential interest for the symptomatic management of OA.
authors.affiliation: WHO Collaborating Center for the Public Health Aspect of Musculoskeletal Disorders, University of Liege, Belgium. olivier.bruyere@ulg.ac.be
authors.forename: Olivier
authors.initials: O
authors.lastname: Bruyère
authors.forename: Nansa
authors.initials: N
authors.lastname: Burlet
authors.forename: Pierre D
authors.initials: PD
authors.lastname: Delmas
authors.forename: René
authors.initials: R
authors.lastname: Rizzoli
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Reginster
mesh_terms: D000880:Anthraquinones / Q000008:administration & dosage / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002116:Calcitonin / Q000008:administration & dosage / Q000009:adverse effects; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000009:adverse effects; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D012968:Etidronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005944:Glucosamine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D010003:Osteoarthritis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects; D000068296:Risedronic Acid; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000880:Anthraquinones; D018501:Antirheumatic Agents; D009942:Organometallic Compounds; D010936:Plant Extracts; D013876:Thiophenes; C081587:strontium ranelate; C025292:diacerein; D006820:Hyaluronic Acid; D002116:Calcitonin; D002809:Chondroitin Sulfates; D000068296:Risedronic Acid; D012968:Etidronic Acid; D005944:Glucosamine