Talk:Osteoarthritis/Archive 3

Wikipedia/Style - can of worms
The word 'boswellia serrata' described here as "gum resin extracted from a tree", sounds like it is equivalent to the words "syrup", "resin" or "amber". It seems there is something confusing about boswellia serrata because on the above page, as well as the linked, Wikipedia page, I can't find any consistency to the capitalization and italicization of the word because I find all of these combinations on the pages: I'm pretty sure people put maple syrup on pancakes as opposed to maple syrup, Maple syrup Maple syrup, Maple Syrup, or Maple Syrup. What is the logic of the conflicting style usage of this word?Sthubbar (talk) 00:14, 29 December 2016 (UTC)
 * No capitalization, no italics
 * No capitalization, italics
 * First word only capitalized, no italics (middle of sentence)
 * First word only capitalized, italics (middle of sentence)
 * Both words capitalized, no italics
 * Both words capitalized, italics
 * Binomial nomenclature, seems to explain that the correct style is 'First word only capitalized, italics' always. Let's head on over to Boswellia serrata and do a consistency check.  Having learned something new, now the day is complete.Sthubbar (talk)  —Preceding undated comment added 00:23, 29 December 2016 (UTC)

Why such a major re-write
, I appreciate your attention to the Alternative Medicine section. The major re-writes are concerning to me for these reasons: 1) Pushing vegetarian/vegan agenda - It seems irrelevant to the topic of osteoarthritis, the source of glucosamin, chondroitin, as well as the other medications. For those of su interested, we can go to the detailed page of each and no need to clutter up this article.
 * 1) Pushing vegetarian/vegan agenda
 * 2) Promoting commercial brands
 * 3) Undue emphasis for ASU and SKI 306X

2) Promoting commercial brands - ASU is a product available from many manufacturers and there is no good reason to believe that only the one brand name added is necessary. The SKI 360 is already a brand name and there is no need to specify any information about the manufactuer.

3) Undue emphasis for ASU and SKI 306X - I completely understand why we have a long paragraph for glucosamine and even for chondroitin. Having such a long paragraph for ASU seem like undue weight.  Same for SKI 306X.  The previous sentence with no undue emphasis seems fair. As you are a more experienced editor, I request your response before I undo these new changes.Sthubbar (talk) 01:57, 30 December 2016 (UTC)
 * your "concerns" about agendas are made-up bullshit. this and related articles got all fucked up recently and am fixing it. will finish tomorrow and you can see what the finished thing looks like. Jytdog (talk) 02:06, 30 December 2016 (UTC)
 * please provide sources for other brands of ASU. I looked and didn't find any; maybe i missed something. it is common as dirt that we mention brand names in the only place where a product is discussed in WP, but if there are actually tons of them then yes we can omit the brand. Jytdog (talk) 02:09, 30 December 2016 (UTC)
 * , ok. I'm really not understanding why you seem to have deleted the SKI 306X page.  It sure makes much more sense to put that whole paragraph you have there on a separate SKI 306X page.  Same for ASU.  Shouldn't week keep the OA page short and link to a separate page for every medicine?  Keep them equal?  I stonrly suggest moving all of the ASU and SKI 306 info to a dedicated page. SAMe is a much more common supplement than either of those two and if SAMe only gets one word in the article, then surely these two only deserve one word.  Otherwise we need to put, at least, one long paragraph for SAMe.Sthubbar (talk) 02:15, 30 December 2016 (UTC)
 * , I'd be interested to learn more what is so "fucked up" about this and related pages because I don't see it.Sthubbar (talk) 02:18, 30 December 2016 (UTC)
 * FYI, please reference here for alternative formulations of ASU.Sthubbar (talk) 06:56, 30 December 2016 (UTC)
 * great ref, thanks. revised accordingly here. Jytdog (talk) 07:19, 30 December 2016 (UTC)

, would you provide an opinion on Jytdog's expansion of ASU, SKI 306X, and phytodolor? The information he is adding is interesting and would go great on dedicated pages for each of those medications, and is not relevant to OA. Can we please put all this information on a dedicated page for each medicine and return the OA page to the way it was?Sthubbar (talk) 07:54, 31 December 2016 (UTC)

The opinion of one author versus secondary/tertiary reviews with multiple authors
, what is up with, which seems to be an opinion paper by a single author being considered reliable when double-blind, placebo controlled trials with multiple authors are rejected until there is a meta-analysis of multiple such trials?Sthubbar (talk) 07:43, 30 December 2016 (UTC)
 * That ref is supporting content that would fall under "society and culture" in a full article; it is not supporting content that is WP:Biomedical information. We don't use primary sources (ones that describe any kind of experimental work including a clinical trial) to support content that is biomedical information.  Please read WP:MEDRS and if you don't understand it please ask. Jytdog (talk) 07:46, 30 December 2016 (UTC)
 * , I'm curious where you are planning to go with the updates you are making. How is a discussion about "society and culture" relevant to a particular medication for the management of OA?  Why such a large emphcasis on two random treatment options?  You have said that you will update soon, so I will give you time to make it clear.  Maybe you plan to make equivalent expansions for all of the listed medications.Sthubbar (talk) 08:59, 30 December 2016 (UTC)

"based on curcumin not curcumin itself"
, what does that mean?Sthubbar (talk) 13:33, 2 January 2017 (UTC)
 * Looking in more detail. Have restored as I misread the abstract. Doc James  (talk · contribs · email) 14:13, 2 January 2017 (UTC)

Phytotherapy is alt med
Does not need its own section. Doc James (talk · contribs · email) 13:18, 3 January 2017 (UTC)
 * , phytotherapy and alternative medicine are diametrically opposed as defined by wiki. Phytotherapy = "science-based medical practice", Alternative medicine="disproven, unproven, impossible to prove, or only harmful".  The treatments listed are supported by review articles, they are definitely not disproven, unproven, impossible to prove or only harmful.  They definitely are science-based.  The alt med label is a smear and phytotherapy is the accurate description.  How am I misreading this?Sthubbar (talk) 14:24, 3 January 2017 (UTC)
 * Alt med is not "disproven, unproven, impossible to prove, or only harmful" Some alt med is partly evidence based Doc James  (talk · contribs · email) 09:41, 4 January 2017 (UTC)
 * , if that is true, then will you support a re-write of the intro sentence of Alternative Medicine? From


 * "practices claimed to have the healing effects of medicine but are disproven, unproven, impossible to prove, or only harmful." to something more neutral like
 * "practices not widely accepted by evidence-based medicine, even if there does exist evidence or the effects of the medicine is disproven, unproven, impossible to prove, or only harmful."Sthubbar (talk) 10:07, 4 January 2017 (UTC)
 * Best to raise that discussion their. Doc James  (talk · contribs · email) 10:32, 4 January 2017 (UTC)

NSAIDs
Hip and knee OA - NSAID works but safety concerns, paracetamol alone useless 10.1016/S0140-6736(17)31744-0 JFW &#124; T@lk  11:58, 7 July 2017 (UTC)

Drugs under development
An IP user added this content and references. The "drugs" are actually candidate therapeutics not yet completed through the approval process, i.e., they may or may not prove to be effective and safe. This is primary research and inaccurately forecasts potential efficacy, making the content and sources WP:CRYSTAL and unencyclopedic, leading to their removal. --Zefr (talk) 14:35, 4 November 2017 (UTC)
 * There are currently (fall 2017) no DMOADs, however there are currently several drugs in clinical trial for that indication.


 * Sprifermin, aka FGF18.
 * MIV-711, cathepsin K inhibitor, in Phase IIa as of Oct 2017.
 * SM04690, (Samumed), Wnt inhibitor, has completed Phase II (Jul 2017)
 * Invossa (TissueGene), has completed Phase III, is available in Korea, is claimed to be a DMOAD, and is targeted to be available in the US in 2023
 * Adipoa, a join European development, coordinated in CHU of Montpellier by Christian Jorgensen, have completed Phase I, and could be available in 2020

List of drugs should likely not go in this article as they are indeed experimental. I've made Draft:Disease-modifying_Osteoarthritis_Drug_(DMOAD) which should make it clear they are not for human use and currently undergoing studies. I think a list of experimental drugs should be ok as we have lists of other experiments e.g. List_of_experimental_aircraft.

Sebinsf (talk) 05:06, 3 February 2020 (UTC)

self-management educational treatment approaches Comment
Hello, I am updating this article with a few Cochrane reviews. I was planning to share a 2014 Cochrane Review looking at the efficacy of self-management education programs. It conflicts with a 2009 clinical practice guideline released by the American Physiotherapy Association. Does anyone want to help me tackle this? I do not have the experience in the field to understand the conflicting viewpoints and know what the present clinical guidelines are. My next step is to review the 2009 citation that is presently in the article and verify the conclusions (to understand where the 20% is coming from) Here is what I have so far:

Lifestyle changes For overweight people, weight loss may be an important factor. Education may be helpful in the self-management of arthritis, however, a 2014 Cochrane systematic review found that there is no strong evidence that self-management programs have a clinical benefit for people with osteoarthritis. There is some evidence that these programs may slightly decrease pain, improve function, reduce stiffness and fatigue, and reduce medical usage. Clinical practice guidelines released by the American Physical Therapy Association, indicate that educational programs can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip osteoarthritis.

Thanks very much! JenOttawa (talk) 18:39, 30 January 2018 (UTC)

sAME Update
This reference: Rutjes AW, Nüesch E, Reichenbach S, Jüni P (October 2009). "S-Adenosylmethionine for osteoarthritis of the knee or hip" (PDF). The Cochrane Database of Systematic Reviews (4): CD007321. doi:10.1002/14651858.CD007321.pub2. PMID 19821403., is from 2009 so it is reviewing articles from earlier than this. There are much more recent reviews that don't agree with this assessment. Why do you think this is from 2016? Sthubbar (talk) 07:59, 11 March 2019 (UTC)
 * FYI, the other reference is still included after SAME above and it does not agree with the assessment of "not advised" and instead agrees with the above statement.Sthubbar (talk) 08:02, 11 March 2019 (UTC)
 * I looked again and it looks like the reversion was done without carefully checking the edit. The 2016 article is still included and moved to above next to SAME.   As already stated.  The other one that was removed was the 2009 review, which is the only one that says "not advised".  The 2016 reference does not agree with that conclusion, therefore no need to have a separate sentence specifically highlighting SAME. Sthubbar (talk) 08:06, 11 March 2019 (UTC)
 * No new high quality studies per the 2016 review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032142/
 * Do you have evidence that high quality evidence now supports s-adenosyl methionine? Doc James  (talk · contribs · email) 09:26, 11 March 2019 (UTC)
 * The point is not about high quality evidence. The first sentence is already qualified as "may be effective".  The contentious point is the qualification of "not advised" which is only supported by the old review and there are 3 earlier reviews that disagree.  Furthermore, the sentence is out of place as sAME is already included and reference above with a weak qualification and 3 supporting references.  I take issue with the "not advised" and with the extra sentence, and the 10 year old reference.  Make sense? Sthubbar (talk) 09:53, 11 March 2019 (UTC)
 * , ok let me try and lay this out more clearly:


 * 2016 - = no difference with COX-2 inhibitor NSAID, ignores 2010 & 2012 data
 * 2012 - = "?" paid article
 * 2010 - = "effective in the management of OA"
 * 2009 - = "may be potentially clinically relevant" "not be advised"
 * All of the reviews seem to agree that sAME is safe. They all seem to agree with the first sentence referencing sAME that says "may be effective".  The justification for my edit was for these 3 reasons:

Your thoughts? Sthubbar (talk) 02:19, 14 March 2019 (UTC)
 * 1) Remove 10 year old review when there are 3 earlier ones.
 * 2) Remove unneccessary sentence highlighting one treatment when it is already mentioned
 * 3) Remove characterization of "not be advised" because it is only mentioned in one 10 year old review and disagrees with more recent reviews.
 * Cochrane is a very good source. This is a not heavily researched topic area. We do not have newer better reviews.
 * Add the conclusion from the other one. Doc James  (talk · contribs · email) 08:17, 14 March 2019 (UTC)
 * Doc James, thank you for the update. I have kept all references with my edit.  I just moved all of the SAMe information into one area.  There is no need to further highlight the 2010 reference, although it is still included there as another supporting evidence for "may be effective".  I just simplified the Cochrane review sentence a little bit, keeping the spirit and reference.Sthubbar (talk) 08:32, 14 March 2019 (UTC)
 * Okay sounds good. Doc James  (talk · contribs · email) 09:26, 14 March 2019 (UTC)

Herbal and predatory sources
This edit was removed because the sources were from alternative medicine, predatory, or outdated (WP:MEDDATE, before 2014) journals. The "Other remedies" section already steps outside the quality expected to justify discussion of potential therapies, as most clinical studies were inconclusive or poorly designed. Only Cochrane reviews or similar quality sources and herbs should be discussed in this section. --Zefr (talk) 02:33, 15 March 2019 (UTC)
 * This edit, has removed 10+ references and 6 treatments. Many of these review articles have been reviewed for years and discussed at length.  It also is inconsistent as the Silva2011 reference is still included, yet it's support for phytodolor is removed.Sthubbar (talk) 02:40, 15 March 2019 (UTC)
 * It sounds like you are saying that any reference before 2014 should be removed and when I removed a 2009 reference it was reverted. How does that work?Sthubbar (talk) 02:47, 15 March 2019 (UTC)
 * These references have been extensively debated on this talk page, so if you want to re-open the discussion, then get consensus here before making such a huge change. We can go through each reference one by one, because this has already been done and consensus has been to accept them as they are.Sthubbar (talk) 02:55, 15 March 2019 (UTC)

Let's approach this systematically. I think you are making three objections 1) Alternative medicine, 2) Predatory, and 3) Outdated. We can just throw out #3.  Just looking at the first 30 references of the article, 43% of them are from before 2014, with the oldest from 1966.  Here are the dates: 1966, 1976, 1985, 2001, 2009(x2), 2011(x3), 2012(x2), and 2013(x2).  So clearly the date of a reference can not simply be used as a reason to remove a reference, unless we wan't to remove a vast majority of references in the whole article.  We can also ignore #1 as the topic at hand is alternative medicines.  That only leaves #2 predatory.  Ok, so we just need to list the journals and see if all articles from these journals should be removed from Wikipedia sitewide.  Here are some of the journals: Is the position that no articles from any of these journals may be used anywhere on the medical Wikipedia pages?Sthubbar (talk) 03:09, 15 March 2019 (UTC)
 * Alternative Medicine Review
 * Nutrition Journal
 * Arthritis Research & Therapy
 * PM&R
 * International journal of molecular sciences
 * Current drug targets
 * Alternative Therapies in Health and Medicine
 * A Google search of each of these journals along with the term predatory returns zero results, except for "International journal of molecular sciences" which is a favorable discussion that it is not predatory. Please provide evidence that any of these journals are predatory.Sthubbar (talk) 03:59, 15 March 2019 (UTC)
 * We use the most recent high quality sources. Claims about pomegranate are so poor they should not be included per User_talk:Doc_James. There are multiple issues with the claim including no studies in humans. Doc James  (talk · contribs · email) 10:48, 15 March 2019 (UTC)
 * Factors for judging quality and reliability for the above list of publications used in this edit, where any one deficiency makes it questionable and removable under challenge: 1) whether the article is preliminary research or a quality review, 2) impact factor, 3) presence on lists for scam/predatory publishers, cataloged as WP:CRAPWATCH, 4) WP:MEDDATE (within 5 years, depending on quality), and 5) WP:CHALLENGE: the editor wishing to preserve challenged sources and content has the burden to convince others of the content and source quality. --Zefr (talk) 14:18, 15 March 2019 (UTC)


 * Alternative Medicine Review: crapwatch
 * Nutrition Journal: primary research
 * Arthritis Research & Therapy: outdated (2006)
 * PM&R: low impact
 * International journal of molecular sciences: crapwatch
 * Current drug targets: crapwatch
 * Alternative Therapies in Health and Medicine: low impact

More poor sources
Devil's claw,

This has an impact factor of zero. Making it not really a reliable source. Doc James (talk · contribs · email) 10:55, 15 March 2019 (UTC)

Another one

 * Alternative Therapies in Health and Medicine also is questionable. Doc James  (talk · contribs · email) 11:00, 15 March 2019 (UTC)

Thank you both for the discussion. For 'Nutrition Journal' there are two PMID, both listed as 'Review' articles. Which is primary research and why is it listed as a review? Thanks. Sthubbar (talk) 17:04, 15 March 2019 (UTC)
 * Let's just say that i) any article in Nutrition Journal about a clinical condition like osteoarthritis should raise suspicion about quality of the underlying clinical research (clinical authors with solid reviews wouldn't publish there), ii) any discussion about dietary or topical herbal remedies being "antioxidants" is suspect as baloney because herbal extracts perform as antioxidants only in a test tube, and iii) all the clinical studies reviewed in the two Nutrition Journal articles used - PMID 26728196 and PMID 26818459 (current refs #122, 124) - are primary, weak designs (Table 2 in the Grover study and Table 1 in the Oe study) mainly published in non-credible alt-med journals. Seemingly out of desire for content balance - because herbal products have received substantial attention as possible therapies for osteoarthritis -  we retain the two reviews to mention herbals under some current use and further study. Particularly the hyaluronan analysis by Oe et al. is primary research and of little-to-no value. Why anyone with scientific training would think that orally taking hyaluronan (a digestible polysaccharide) to magically benefit knee cartilage is a mysterious failure of reasoning. --Zefr (talk) 17:57, 16 March 2019 (UTC)
 * Zefr, thank you for the reply. I'm not following all of your points and we can just leave it there.Sthubbar (talk) 05:26, 18 March 2019 (UTC)

Foundations 2 2019, Group 8b goals
Zaccarlson (talk) 21:18, 30 July 2019 (UTC)
 * 1) Add up-to-date and relevant information about pharmacologic treatment options, including recent studies.
 * 2) Add information about efficacy of tramadol in osteoarthritis:
 * 3) Cochrane review: Toupin April, Karine; Bisaillon, Jacinthe; Welch, Vivian; Maxwell, Lara J; Jüni, Peter; Rutjes, Anne WS; Husni, M Elaine; Vincent, Jennifer; El Hindi, Tania (2019-05-27). "Tramadol for osteoarthritis". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005522.pub3. ISSN 1465-1858. PMC 6536297. PMID 31132298.
 * Note that you can use the cite drop down menu to have Wikipedia add a reference, like so. Health policy (talk) 05:01, 31 July 2019 (UTC)
 * Thank you. I'm going to add the above reference to the following sentence, "This is due to their small benefit and relatively large risk of side effects," since it seems that this updated Cochrane review supports this argument.

Zaccarlson (talk) 21:04, 1 August 2019 (UTC)

Foundations 2 2019, Group 8c peer review, Vivian
Unfortunately, Jane’s edits were removed and Jane’s edits were the one that addressed the groups goals so continuing to find better review articles on the pharmacological treatment of osteoarthritis will be important. If you need help refining your search, I would suggest expanding on opioid and tramadol use in osteoarthritis (i.e. prevalence, addiction prevalence, etc) and use of CBD and other cannabis products since I have seen about 1 in 5 patients report MJ/CBD use for their pain. Although MJ research is currently limited, it would be interesting to include under treatment options if possible. For the other edits, they were neutral but very ambiguous due to lack of evidence for/against surgery and for/against certain lifestyles. Since there is a lack of evidence for/against each side, these edits could be improved by including debated pros/cons of surgery to help improve the article. Otherwise, I really like the groups' goals for this article since it’s a huge area of treatment.

Vivianle17 (talk) 21:16, 5 August 2019 (UTC)

Foundations 2 2019, Group 8C peer review, Mehr
The groups first goal about addressing treatment options wasn't elaborated on because of the information and citations already provided and matching their research. It's a very fleshed out section in the article and covers a wide variety of treatments with strong pieces of evidence. The group chose to address tramadol as their second goal but it was removed by another user. It appears as though primary sources were used but finding reviews would be a great next step in solidifying this as a treatment option. The group made an effort to touch upon their goals and I think with more time would have been easily able to achieve them in totality. Their edits are all within the framework of Wikipedia's manual of style and are sure to use the proper capitalization, punctuation, and grammar in addition to proper formatting in source citation within the text.

Mvirk422 (talk) 21:41, 5 August 2019 (UTC)

Foundations 2 2019, Group 8b Peer Review (8C), Francesca
Do the group’s edits substantially improve the article as described in the Wikipedia peer review “Guiding framework”? The group has added additional information on some of the conflicting viewpoints regarding osteoarthritis which gives readers additional information to consider. The group has also added references which helps validate the information listed in the article. Has the group achieved its overall goals for improvement? The group needs to address additional information regarding pharmacological therapy and medications. There was also no additional information listed regarding Tramadol. '''Are the points included verifiable with cited secondary sources that are freely available? If not, specify…''' Yes, all edits included appropriate citations to freely available articles that fall under Wikipedia's guidelines. Francesca.alcala.96 (talk) 16:53, 7 August 2019 (UTC)
 * 1) Add up-to-date and relevant information about pharmacologic treatment options, including recent studies.
 * 2) Add information about efficacy of tramadol in osteoarthritis:

Text
1) This makes no sense / is wrong "The formation of hard knobs at the near joints of the fingers (known as Bouchard's nodes)"

2) This has no reference "In many cases, the cause is unknown."

3) This is unclear "The most commonly involved joints are the two joints in the fingers" as there are three joints.

4) WP:ANDOR Doc James  (talk · contribs · email) 01:35, 9 October 2019 (UTC)

Primary vs Secondary OA
It is not exactly accurate to list Primary and Secondary OA under the "Risk Factors" heading. Primary vs secondary is a way to classify OA (although a bit of an artificial distinction) so risk factors should probably be its own section. Opening it up for discussion before taking a stab at it. Pattkait (talk) 13:55, 9 October 2019 (UTC)
 * Good point. This whole section is on causes, not risk factors, as evidenced by the first sentence. I will change section title and see how you and others respond. Regards, IiKkEe (talk) 14:57, 9 October 2019 (UTC)
 * Happy with changing it to "causes" Doc James  (talk · contribs · email) 07:26, 10 October 2019 (UTC)

Senescent cells
Please add something on this topic because it appears these cells play significant role when treating. Here is a relevant article. --5.43.72.107 (talk) 13:53, 19 October 2019 (UTC)

❌: That's early-stage lab research and conjecture, many years from development as a testable concept or drug. Unencyclopedic. --Zefr (talk) 14:46, 19 October 2019 (UTC)