Osteoarthritis of the knee : hyaluronic acid is no longer reimbursed

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Published the 13.10.2017 at 17h23

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Keywords :

Arthrosegenouacide Hyaluroniquerhumatologie

The coincidence of timing does not send a good signal to the 10 million people suffering from osteoarthritis. On the day of the global Day of rheumatism, on the 12th of October, the ministry of Health and the public Accounts published a decree in the official Journal aiming to put an end to the reimbursement of the Hyalgan. It was the last treatment based on hyaluronic acid that are supported by the Insurance up to 15 %.

The ministers believe ” that no demonstration evidence does not establish the superiority of this specialty compared to placebo or compared to medical devices with the same therapeutic target “. These have also been the subject of déremboursement on the 1st of June last.

And from today, France not to reimburse more no injection of hyaluronic acid to reduce pain caused by osteoarthritis. The sick will have to pay out of pocket. In addition to the inequality of access to treatments, the rheumatologists report an “absurd decision” which promotes the use of the pose of knee prosthesis. Dr Emmanuel Maheu, a rheumatologist at the hôpital Saint-Antoine (Paris) also feared a deregulation of the market, and the arrival of the products is poorly controlled.

In the order, the ministers mentioned the physical exercise as an alternative to hyaluronic acid. What is it ?
Dr Emmanuel Maheu : They resemble, indeed, the implementation of ” measures on a healthy diet and nonpharmacological treatments “. These recommendations are very interesting in patients who are not ill to prevent the seizures. But the first thing to do when a patient is in pain is to reduce pain to an acceptable level to allow a resumption of a physical activity.

Patients with oa have the feeling of not being taken seriously, not to be listened to and that doctors have nothing to offer to relieve their pain. A mistrust that will grow stronger with this kind of recommendation.

Listen…

Emmanuel Maheu, a rheumatologist at the hôpital Saint-Antoine (Paris) : “With the déremboursement, any doctor can do the injections…”

Are there treatments able to alleviate the pain of patients ?
Dr Emmanuel Maheu : patients who suffer from osteoarthritis of the knee may be harmed by phase, but they may also suffer continuously. The decree recalls that the paracetamol may be used during these phases symptomatic. However, recent analyses show that this drug has no effect on the pain. Recent articles have also raised questions as to its good tolerance. In making continuous, patients would not face only a risk of liver but also to a cardiovascular risk, and renal failure.

The ministers also advise the use of nonsteroidal anti-inflammatory drugs (NSAIDS) in the ” acute phase “. Here’s a good public health policy : one dérembourse of the drug is not dangerous and we told the patients to take anti-inflammatory drugs. I recall that with these drugs there is a significant risk of bleeding and stomach ulcer, renal insufficiency in the elderly and cardiovascular complications. This is utter nonsense.

Finally, we are asked to use the injections intra-articular corticosteroid. This treatment works very well, but in specific situations : the flares of the knee with presence of an effusion.

In reality, these various drugs are not alternatives to a treatment that aims to improve the long-term. We offers only treatments of crisis that have a balance benefit/ risk months good as hyaluronic acid.