Preface

Osteoarthritis (OA) is one of the most prevalent and chronic diseases affecting the elderly. Its most prominent feature is the progressive destruction of articular cartilage which results in impaired joint motion, severe pain and ultimately disability. Its prevalence and its impact on daily life pose a significant public health problem. Today, a cure for OA remains elusive and the management of OA is largely palliative focusing on the alleviation of symptoms. Current recommendations for the management of OA include a combination of pharmacological and non-pharmacological treatments. The term “non-pharmacological” includes physical therapy and rehabilitation, “nutraceuticals” or food supplements and surgical treatments. This book focuses on physical therapies, rehabilitation and nutraceuticals, while surgical treatments are not discussed. All guidelines on OA management highlight the importance of weight loss and physical activity to improve the functional status of OA patients. Although they are not recommended, a number of other therapies are commonly used by physicians and physical therapists in their daily practice. These techniques are not recommended because their efficacy is not evidenced by strong clinical trials. This category includes electrotherapy, ultrasound, electromagnetic field, spa, hydrotherapy, etc. The clinical relevance of these techniques and the difficulties in conducting high quality trials assessing their efficacy are stated by authors. This book is really a guide of good clinical practice for all health care professionals in charge of patients with OA.

Pharmacological management of OA is dominated by analgesic, nonsteroidal anti-inflammatory drugs, and Symptomatic Slow Acting Drugs (SYSADOA) which constitute a new class of drugs characterised by a slow action on OA symptoms and a good tolerability. Some SYSADOA are nutraceuticals (i.e. glucosamine, chondroitin sulphate, avocado/soybean unsaponifiable) and are provided as dietary supplements or prescribed drugs according to the country and the product specifications. The absence of a clear definition and requirements for registration of nutraceuticals throws the scientists and practitioners into confusion. Often data coming from preclinical and clinical studies of prescribed drugs are extrapolated to over-the-counter products which differ considerably in source, formula, purity, rhythm and dose administrated. In fact, more than 30 nutraceutical products are marketed as potentially active in OA but few have demonstrated their efficacy and safety in human clinical trials. Clearly, in terms of regulations, there is a need to resolve the general confusion about whether nutraceuticals are food supplements or medicines. This book aims to review the available scientific evidence supporting the efficacy, and explaining the mechanism of action of nutraceuticals targeting OA. It also gives the recent advances in term of nutraceuticals nomenclature, classification and regulation.