Effectiveness, safety, and cost-utility of a knee brace in medial knee osteoarthritis: the ERGONOMIE randomized controlled trial

OBJECTIVE

This pragmatic, multicenter, open-label, randomized controlled trial (RCT) aimed to compare the effectiveness, safety, and cost-utility of a custom-made knee brace versus usual care over 1 year in medial knee osteoarthritis (OA).

DESIGN

120 patients with medial knee OA (VAS pain at rest >40/100), classified as Kellgren-Lawrence grade II-IV, were randomized into two groups: ODRA plus usual care (ODRA group) and usual care alone (UCA group). The primary effectiveness outcome was the change in VAS pain between M0 and M12. Secondary outcomes included changes over 1 year in KOOS (function) and OAKHQOL (quality of life) scores. Drug consumption, compliance, safety of the knee brace, and cost-utility over 1 year were also assessed.

RESULTS

The ODRA group was associated with a higher improvement in: VAS pain (adjusted mean difference of -11.8; 95% CI: -21.1 to -2.5); all KOOS subscales (pain: +8.8; 95% CI: 1.4-16.2); other symptoms (+10.4; 95% CI: 2.7-18); function in activities of daily living (+9.2; 95% CI: 1.1-17.2); function in sports and leisure (+12.3; 95% CI: 4.3-20.3); quality of life (+9.9; 95% CI: 0.9-15.9), OAKHQOL subscales (pain: +14.8; 95% CI: 5.0-24.6); and physical activities (+8.2; 95% CI: 0.6-15.8), and with a significant decrease in analgesics consumption at M12 compared with the UCA group. Despite localized side-effects, observance was good at M12 (median: 5.3 h/day). The ODRA group had a more than 85% chance of being cost-effective for a willingness-to-pay threshold of €45 000 per QALY.

CONCLUSIONS

The ERGONOMIE RCT demonstrated significant clinical benefits of an unloader custom-made knee brace in terms of improvements in pain, function, and some aspects of quality of life over 1 year in medial knee OA, as well as its potential cost-utility from a societal perspective.

[Gustatory disorders during multiple sclerosis relapse]

Gustatory dysfunction is a known but uncommon element in the course of multiple sclerosis. Gustatory dysfunction has been described during the chronic progressive phase and during the relapse phase. We report five patients with clinically definite multiple sclerosis who developed transient gustatory disorders during the relapse phase of their disease. Agueusia occurred as one of the first symptoms in three patients, revealing the disease. Symptoms generally improved with remission or corticosteroid administration. These disorders are due to demyelinating lesions of the gustatory pathways in the thalamus or brainstem. MRI studies were not performed during the relapse phase and no clinical neuroimaging correlations could be established. Agueusia may be accompanied by olfactory dysfunction which is due to plaque demyelinization of the olfactory pathways, particularly in the temporal and inferior frontal lobes. Taste anomalies can also be observed in other diseases, including systemic diseases such as sarcoidosis or Sjogrën's syndrome. Drug-induced gustatory disorders are also reported.

Arthritis following combined vaccine against diphtheria, polyomyelitis, and tetanus toxoid

We describe 2 cases of arthritis following immunization against diphtheria, poliomyelitis and tetanus toxoid. One patient developed monoarthritis of the knee after immunization, that regressed following synovectomy. Five years later, the arthritis recurred after a booster vaccine injection. One day after immunization, another patient developed arthritis of the ankle that persisted for 3 days. It is difficult to know whether there is a coincidental or a causal relation between immunization and arthritis. Although our cases suggest that immunization against diphtheria, poliomyelitis and tetanus toxoid may cause arthritis, additional cases must be reported before studies aimed at confirming this possibility are considered.

[Ureteral triplication and contralateral ureteral duplication. Apropos of a case]

Authors report a case of right ureteral triplication complicated with right hydronephrosis of the upper kidney and vesico-ureteral reflux concerning the middle kidney. Surgical technique is illustrated and a brief review of literature completes this case-report.

[Aspergillus prostatitis and prolonged corticotherapy. Apropos of a case report]

Aspergillosis prostatitis is rare but more frequent to immunodeficiency people. We report a case of aspergillosis prostatitis associated with pulmonary tuberculosis, after a corticosteroid treatment for retroperitoneal fibrosis to Methysergide.