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The optimal treatment of osteoarthritis requires the combination of pharmacological and non-pharmacological treatments. The non-pharmacological treatments recommended by the medical and scientific associations are information, education, weight management (especially in case of overweight) and physical activity. Antalgic and anti-inflammatory pharmacological treatments should be used to facilitate the recovery and regular physical activity that is central in the management of osteoarthritis patients. It should include aerobic cardio-respiratory, resistance, flexibility and neuromuscular reprogramming and be associated with cognitive-behavioral therapies. Health professionals have to promote the activity and to inform their patients about the benefits, not only about the symptoms of osteoarthritis, but also about their overall health., Competing Interests: Y. Henrotin déclare des liens permanents avec Artialis SA -participation financière au capital de l’entreprise, contrat de travail et rémunération régulière- et des liens ponctuels avec Tilman, Thuasne et Expanscience -interventions et/ou prises en charge lors de congrès-. C. Demoulin déclare n’avoir aucun lien d’intérêts. C. Mathy déclare n’avoir aucun lien d’intérêts.

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

This paper summarizes the guidelines published by the Osteoarthritis research society International (OARSI) and compares these guidelines with others. The OARSI guidelines are based on a systematic review of the literature, a meta-analysis and an expert consensus. The OARSI has developed 25 guidelines including 8 for pharmacology modalities, 12 for non-pharmacology modalities and 5 for surgery modalities. The usefulness of the guidelines in the daily practice is very low. The barriers for the guidelines implementation are the lack of interest of the practitioners, the lack of scientific advances in the OA diagnosis and treatments and the low applicability of these guidelines in the daily practice., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

This article aims to recommend easy, reproducible and valid physical tests and questionnaires to allow a functional and physical assessment of sub-acute and chronic low back pain patients. We recommend the pain visual analogue scale, the French translation of the Roland-Morris Disability Questionnaire (EIFEL) and the Dallas questionnaire to appreciate pain intensity and its influence on patients' quality of life. Sorensen's test is recommended in order to assess trunk extensor muscles endurance. We suggest to measure pelvic and lumbar flexion mobility by means of the inclinometer technique. The test described by McQuade is recommended to assess abdominal muscles static endurance.

The aim of this article is to critically review the potential role of aceclofenac in the treatment of inflammatory pain and chronic osteoarticular disorder, based on its activity on the mediators of inflammation, its effect on cartilage remodeling and on the results of clinical studies comparing aceclofenac with other NSAIDs in these disorders. Aceclofenac has an outstanding anti-inflammatory profile, involving besides a classical inhibition of prostaglandins E2, a decrease in the expression of several cytokines including interleukin 1 and tumor necrosis factor alpha. It also inhibits activated oxygen species production and influences cells adhesion. Aceclofenac and its main metabolite, 4-hydroxyaceclofenac, has positive effects on cartilage anabolism combined with modulating effect of matrix catabolism. Clinically, aceclofenac has been consistently shown to have a similar efficacy than that of widely marketed NSAIDs and a tolerance profile at least as good, if not better than the profile observed for other NSAIDs in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. As of today, no head to head comparison between aceclofenac and coxibs have been performed, nor for efficacy neither for tolerance. The specific profile of aceclofenac makes this NSAID an interesting candidate for long-term treatment of chronic rheumatic disorders as well as for treatment of acute inflammatory episodes.

Inflammatory processes are the physiological response of the organism to different stimuli such as trauma, infections or immunological reactions. The events leading to inflammation are characterized by leukocytes adhesion to the endothelium, diapedesis and migration, cells activation and tissue remodelling. These processes are initiated and regulated by a great variety of inflammatory mediators including cytokines, prostanoids, leukotrienes, neuropeptides, reactive oxygen and nitrogen species, complement components, coagulation factors and metalloproteases. This paper is devoted to the description of the major local effects of these mediators in the inflammatory reaction.

Besides the management of symptoms of osteoarthritis, a lot of interest was raised for molecules aiming at slowing down the structural progression of the disease. This paper summarizes the currently available data allowing to discuss the efficacy and tolerance of these chemical entities.

Osteoarthritis is now considered in all developed countries as a major burden for public health. During several years, the pharmacological management of osteoarthritis mainly focused on symptoms relief without interaction with the long-term structural progression of this disease. Based on recently published consensus, the present article summarizes the currently available options in the symptom-modifying management of osteoarthritis.