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Article: Systematic review of therapies for osteoarthritis of the hand.

Towheed, T E

2005 Volume 13, Issue 6, Page(s) 455–462

Abstract: Objective: To systematically review published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA), with an emphasis on trial methodology.: Methods: RCTs published ... ...

Abstract	Objective: To systematically review published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA), with an emphasis on trial methodology. Methods: RCTs published between 1966 and August 2004 were identified by searching several electronic data sources as well as by searching reference lists. Details of study demographics, methodology, quality and outcomes were analyzed. A meta-analysis was planned, if feasible. Results: Thirty-one RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this systematic review. When compared with hip and knee OA, there are surprisingly few published RCTs in hand OA. Generally, these RCTs are of low quality. RCTs are weakened by a lack of consistent case definition and by a lack of standardized outcome assessments. The methods used for randomization, blinding, and allocation concealment were rarely described. The number and location of symptomatic hand joints per treatment group at baseline was usually not stated. The number and location of evaluated hand joints at the end of the study was also usually not stated. A meta-analysis could not be performed since most of the treatments studied did not have more than one identical comparison to allow pooling of the data. Conclusion: It is apparent that hand OA is a more complex area in which to study the efficacy of therapies when compared to hip and knee OA. Consensus guidelines are urgently needed to help improve the design and conduct of RCTs in hand OA. Additional RCTs of high quality that follow consensus recommendations are needed to evaluate the wide range of possible therapeutic options available for patients with hand OA.
MeSH term(s)	Aged ; Female ; Hand ; Humans ; Male ; Middle Aged ; Occupational Therapy/methods ; Osteoarthritis/drug therapy ; Osteoarthritis/therapy ; Randomized Controlled Trials as Topic/methods ; Research Design ; Splints ; Yoga
Language	English
Publishing date	2005-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2005.02.009
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Article ; Online: Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study.

Billington, E O / Leslie, W D / Brown, J P / Prior, J C / Morin, S N / Kovacs, C S / Kaiser, S M / Lentle, B C / Anastassiades, T / Towheed, T / Kline, G A

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

2021 Volume 32, Issue 7, Page(s) 1313–1320

Abstract: ... recipients had expected mean (SD) femoral neck T-scores of - 1.5(1.0) and - 0.8(1.0), 10-year major ... respectively. At age 80, untreated women and zoledronic acid recipients had expected femoral neck T-scores ... and 4.4%(4.5), respectively. The expected proportion of women with femoral neck T-score ≤ - 2.5 was 14 ...

Abstract	Prevention of early menopausal bone loss may reduce the future burden of osteoporosis. In this modelling exercise, an osteoporosis prevention strategy involving 5-year infusions of zoledronic acid, beginning early in menopause, reduced long-term fracture risk and the proportion of aging women with femoral neck densitometric osteoporosis. This strategy warrants further evaluation. Introduction: Preventing early menopausal bone loss may substantially reduce the future burden of osteoporosis. We modelled the effects of infrequent zoledronic acid infusions on long-term fracture risk. Methods: Data from the Canadian Multicentre Osteoporosis Study (CaMos) were used to determine the expected natural history of femoral neck areal bone mineral density (BMD) and fracture risk (using FRAX®) from ages 50-80 for women with no antiresorptive drug exposures. We modelled the effects of three infusions of zoledronic acid (at ages 50, 55, 60) on long-term fracture risk, assuming this intervention would preserve BMD until age 65 years, followed by losses mirroring early menopausal BMD loss. Results: At age 65, untreated women and zoledronic acid recipients had expected mean (SD) femoral neck T-scores of - 1.5(1.0) and - 0.8(1.0), 10-year major osteoporotic fracture (MOF) risks of 9.8%(5.0) and 8.0%(3.7) and hip fracture risks of 1.7%(2.4) and 0.8%(1.2), respectively. At age 80, untreated women and zoledronic acid recipients had expected femoral neck T-scores of - 1.9(0.9) and - 1.4(0.9), MOF risks of 17.9%(8.2) and 14.9%(6.4) and hip fracture risks of 6.3%(6.2) and 4.4%(4.5), respectively. The expected proportion of women with femoral neck T-score ≤ - 2.5 was 14.9% for untreated women and 3.8% for zoledronic acid recipients at age 65, increasing to 28.1% and 12.0%, respectively, at age 80. Numbers-needed-to-treat to prevent one case of densitometric osteoporosis were 9 at age 65 and 5 at age 80. Conclusion: Infrequent infusions of zoledronic acid, initiated early in menopause, are expected to reduce long-term fracture risk and result in a substantial reduction in the proportion of women with densitometric osteoporosis after age 65.
MeSH term(s)	Aged ; Aged, 80 and over ; Bone Density ; Canada ; Feasibility Studies ; Female ; Humans ; Menopause ; Middle Aged ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/etiology ; Osteoporotic Fractures/prevention & control ; Risk Assessment
Language	English
Publishing date	2021-01-12
Publishing country	England
Document type	Journal Article
ZDB-ID	1064892-6
ISSN	1433-2965 ; 0937-941X
ISSN (online)	1433-2965
ISSN	0937-941X
DOI	10.1007/s00198-021-05826-5
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Article: Published meta-analyses of pharmacological therapies for osteoarthritis.

Towheed, T E

Osteoarthritis and cartilage

2002 Volume 10, Issue 11, Page(s) 836–837

MeSH term(s)	Acetaminophen/therapeutic use ; Administration, Topical ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Capsaicin/therapeutic use ; Chondroitin Sulfates/therapeutic use ; Cyclooxygenase Inhibitors/therapeutic use ; Glucosamine/therapeutic use ; Humans ; Indomethacin/therapeutic use ; Meta-Analysis as Topic ; Osteoarthritis/drug therapy ; Osteoarthritis, Knee/drug therapy ; Randomized Controlled Trials as Topic/standards
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal ; Cyclooxygenase Inhibitors ; Acetaminophen (362O9ITL9D) ; Chondroitin Sulfates (9007-28-7) ; Glucosamine (N08U5BOQ1K) ; Capsaicin (S07O44R1ZM) ; Indomethacin (XXE1CET956)
Language	English
Publishing date	2002-11-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1053/joca.2002.0841
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Article ; Online: Systematic review of non-surgical therapies for osteoarthritis of the hand: an update.

Lue, S / Koppikar, S / Shaikh, K / Mahendira, D / Towheed, T E

Osteoarthritis and cartilage

2017 Volume 25, Issue 9, Page(s) 1379–1389

Abstract: Objective: To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not ... ...

Abstract	Objective: To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated. Design: RCTs published between March 2008 and December 2015 were added to the previous systematic reviews. Results: A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators. Conclusion: Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.
Language	English
Publishing date	2017-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2017.05.016
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Article ; Online: Systematic review of non-surgical therapies for osteoarthritis of the hand: an update.

Mahendira, D / Towheed, T E

Osteoarthritis and cartilage

2009 Volume 17, Issue 10, Page(s) 1263–1268

Abstract: Objective: To update our earlier systematic review which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not ... ...

Abstract	Objective: To update our earlier systematic review which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated. Method: RCTs published between August 2004 and February 2008 were added to the original systematic review. Results: A total of 44 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, these RCTs were of low quality. RCTs were weakened by a lack of consistent case definition and by a lack of standardized outcome assessments. The methods used for randomization, blinding, and allocation concealment were rarely described. The number and location of symptomatic hand joints per treatment group at baseline was usually not stated. The number and location of evaluated hand joints at the end of the study was also usually not stated. A meta-analysis could not be performed since most of the treatments studied did not have more than one identical comparison to allow pooling of the data. Conclusions: It is apparent that hand OA is a more complex area in which to study the efficacy of therapies when compared to hip and knee OA. The recently published OARSI Consensus Recommendations will improve the design and conduct of future RCTs in hand OA.
MeSH term(s)	Aged ; Aged, 80 and over ; Evidence-Based Medicine/standards ; Hand ; Humans ; Middle Aged ; Osteoarthritis/therapy ; Randomized Controlled Trials as Topic/standards
Language	English
Publishing date	2009-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2009.04.006
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Article: Quantitative ultrasound: is it a useful test in osteoporosis?

Towheed, T E

Arthritis care and research : the official journal of the Arthritis Health Professions Association

1999 Volume 12, Issue 3, Page(s) 220–226

MeSH term(s)	Humans ; Osteoporosis/diagnostic imaging ; Reproducibility of Results ; Sensitivity and Specificity ; Ultrasonography/instrumentation ; Ultrasonography/methods ; Ultrasonography/trends
Language	English
Publishing date	1999-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/1529-0131(199906)12:3<220::aid-art10>3.0.co;2-c
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Zs.A 2446: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.A 24: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)

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Article: Combination Analgesic Development for Enhanced Clinical Efficacy (CADENCE Trial): Study Protocol for a Double-Blind, Randomized, Placebo-Controlled Crossover Trial of an Alpha-Lipoic Acid - Pregabalin Combination for the Treatment of Fibromyalgia Pain.

Gilron, Ian / Tu, Dongsheng / Holden, Ronald / Towheed, Tanveer / Vandenkerkhof, Elizabeth / Milev, Roumen

JMIR research protocols

2017 Volume 6, Issue 8, Page(s) e154

Abstract: Background: Fibromyalgia is a clinical disorder commonly presenting with chronic widespread pain as well as sleep disturbance, fatigue, depression, and cognitive dysfunction. There is an urgent need for treatment strategies that provide better pain ... ...

Abstract	Background: Fibromyalgia is a clinical disorder commonly presenting with chronic widespread pain as well as sleep disturbance, fatigue, depression, and cognitive dysfunction. There is an urgent need for treatment strategies that provide better pain relief and fewer adverse effects (AEs). Efforts to develop rational combinations of specific fibromyalgia treatments have demonstrated potential for measurable improvements in pain relief, quality of life, and health care utilization. More than half of fibromyalgia patients receive 2 or more analgesics but current combination use is based on limited evidence. As an early proof-of-concept project from the Canadian Institutes of Health Research-Strategy on Patient-Oriented Research Chronic Pain Network, this trial protocol is expected to advance the field by rigorously evaluating a new treatment combination for fibromyalgia. Objective: We will test the hypothesis that analgesic combinations containing at least one nonsedating agent would be as safe but more effective than either monotherapy because of additive pain relief without increasing overall AEs. Pregabalin (PGB), a sedating anticonvulsant, is proven effective for fibromyalgia, and the antioxidant, alpha-lipoic acid (ALA), one of the only nonsedating systemic agents proven effective for neuropathic pain, is currently being evaluated in fibromyalgia. Thus, we will conduct a clinical trial to compare a PGB+ALA combination to each monotherapy for fibromyalgia. Methods: Using a double-blind, double-dummy, crossover design, 54 adults with fibromyalgia will be randomly allocated to 1 of 6 sequences of treatment with PGB, ALA, and PGB+ALA combination. During each of 3 different treatment periods, participants will take 2 sets of capsules containing (1) ALA (or placebo) and (2) PGB (or placebo) for 31 days, followed by an 11-day taper/washout period. The primary outcome will be mean daily pain intensity (0 to 10 scale) at maximal tolerated doses (MTDs) during each period. Secondary outcomes, assessed at MTD, will include global improvement, adverse events, mood, and quality of life. Results: This trial attained ethics approval March 6, 2017 (Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board protocol number ANAE-313-17), and recruitment is set to start in August 2017. Conclusions: This trial will provide rigorous evidence comparing the efficacy of a PGB-ALA combination to PGB alone and ALA alone in the treatment of fibromyalgia. Trial registration: International Standard Randomized Controlled Trial Number ISRCTN14939460; https://www.isrctn.com/ ISRCTN1493946 (Archived by WebCite at http://www.webcitation.org/6sFqAjxkt).
Language	English
Publishing date	2017-08-04
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/resprot.8001
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Article: Glucosamine therapy for osteoarthritis: an update.

Towheed, Tanveer E / Anastassiades, Tassos

The Journal of rheumatology

2007 Volume 34, Issue 9, Page(s) 1787–1790

MeSH term(s)	Administration, Oral ; Animals ; Disease Models, Animal ; Glucosamine/administration & dosage ; Glucosamine/chemistry ; Glucosamine/pharmacology ; Humans ; Osteoarthritis/drug therapy ; Placebo Effect ; Randomized Controlled Trials as Topic ; Treatment Outcome
Chemical Substances	Glucosamine (N08U5BOQ1K)
Language	English
Publishing date	2007-09
Publishing country	Canada
Document type	Editorial
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
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Zs.A 1168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The effect of glucosamine on glucose metabolism in humans: a systematic review of the literature.

Dostrovsky, N R / Towheed, T E / Hudson, R W / Anastassiades, T P

Osteoarthritis and cartilage

2011 Volume 19, Issue 4, Page(s) 375–380

Abstract: Objective: Glucosamine is commonly used for the treatment of osteoarthritis. It is available as an over the counter preparation and also as a prescription pharmaceutical. There is concern from animal experiments that glucosamine may alter glucose ... ...

Abstract	Objective: Glucosamine is commonly used for the treatment of osteoarthritis. It is available as an over the counter preparation and also as a prescription pharmaceutical. There is concern from animal experiments that glucosamine may alter glucose metabolism through the hexosamine biosynthetic pathway. The objective of this systematic review is to determine if exogenous glucosamine adversely affects glucose metabolism in humans. This review does not separate out the effects on glucose metabolism of the various glucosamine preparations. Method: An English-language literature search of MEDLINE, EMBASE and EBM Reviews (1950-February 2009) was conducted. The bibliographies of selected papers were manually searched for additional references. Two reviewers independently analyzed studies for quality and content using a standardized data extraction form. Results: Eleven studies were included. Six studies were randomized controlled trials and the remaining five were prospective studies with or without controls. Four of the studies found decreased insulin sensitivity or increased fasting glucose in subjects taking glucosamine. Three of these were clinical studies using oral glucosamine. Studies that included subjects with baseline impaired glucose tolerance or insulin resistance were more likely to detect an effect on glucose metabolism than studies without such subjects. Conclusion: Clinical studies, including three using oral glucosamine, have provided mixed evidence about the effect of exogenous glucosamine on glucose metabolism in humans. Therefore, more studies are needed, particularly including subjects at high risk for impairments in glucose homeostasis, before a definite conclusion can be made.
MeSH term(s)	Glucosamine/administration & dosage ; Glucosamine/therapeutic use ; Glucose/metabolism ; Humans ; Insulin Resistance ; Osteoarthritis/drug therapy ; Osteoarthritis/metabolism
Chemical Substances	Glucose (IY9XDZ35W2) ; Glucosamine (N08U5BOQ1K)
Language	English
Publishing date	2011-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2011.01.007
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Article ; Online: WITHDRAWN: Celecoxib for rheumatoid arthritis.

Garner, Sarah E / Fidan, Dogan / Frankish, Ruth R / Judd, Maria / Shea, Beverley / Towheed, Tanveer / Tugwell, Peter / Wells, George A

The Cochrane database of systematic reviews

2017 Volume 6, Page(s) CD003831

Abstract: Background: Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of ... ...

Abstract	Background: Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds. The NSAIDs known as the selective Cox II inhibitors, of which celecoxib is a member, were developed in order to reduce the GI toxicity, but are more expensive. Objectives: To establish the efficacy and safety of celecoxib in the management of RA by systematic review of available evidence. Search methods: We searched the following databases up to August 2002: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment Database. The bibliographies of retrieved papers and content experts were consulted for additional references. Selection criteria: All eligible randomised controlled trials (RCTs) were included. No unpublished RCTs were included in this edition of the review. Data collection and analysis: Data were abstracted independently by two reviewers. Data was analysed using a fixed effects model. A validated checklist was used to score the quality of the RCTs. The planned analysis was to pool, where appropriate continuous outcomes using mean differences and dichotomous outcomes using relative risk ratios. This was not however possible due to the lack of data. Main results: Five RCTs were included (4465 participants); three of the studies also enrolled individuals with OA. The comparators were placebo, naproxen, diclofenac and ibuprofen. The evidence reviewed suggests that celecoxib controls the symptoms of RA to a similar degree to that of the active comparators examined (naproxen, diclofenac and ibuprofen). When compared to placebo, the percentage of patients showing improvement according to ACR 20 criteria at week 4 were 42/82 (51%) in the twice daily celecoxib 200mg group and 43/82 (52%) in the twice daily celecoxib 400mg group; these were significantly different from the placebo group in which 25/85 (29%) improved. The six month data reviewed support a reduced rate of UGI complications with celecoxib but there is also evidence to suggest that these benefits may not be evident in the long-term and that celecoxib offers no additional benefit in patients who are also receiving cardio-prophylactic low dose aspirin. Authors' conclusions: For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper GI complications are maintained in the long-term and its increased cost in comparison to traditional NSAIDs.
MeSH term(s)	Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Arthritis, Rheumatoid/drug therapy ; Celecoxib/therapeutic use ; Humans ; Randomized Controlled Trials as Topic ; Sulfonamides/therapeutic use
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal ; Sulfonamides ; Celecoxib (JCX84Q7J1L)
Language	English
Publishing date	2017-06-09
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD003831.pub2
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