Modern approaches to the treatment of osteoarthritis

Abstract

The data given in the article is in accordance with the latest recommendations of ESCEO years 2016, 2019 in regard to possibilities of the sympthom-modifying and structure-modifying action of chondroitin sulfate in the treatment of patients with osteoarthritis. There is the data on the therapy effect when treating patients with osteoarthritis and with periarticular tissues damage with chondroitin sulfate injections (Alflutop, Biotehnos) having strong evidence base, including randomized placebo-controlled studies. In the randomized study it is shown reliably high effectiveness of Alflutop against placebo in regard to main clinical manifestations of the desease as well as possibility to slow down progress of the destructive processes at osteoarthritis of the knee-joint. The data given on estimation of effectiveness and safety of alternate introduction of Alflutop at osteoarthritis 2 ml intramuscularly every other day (10 injections) compared with a standard mode of use of Alflutop 1 ml intramuscularly every day for 20 days. Equal effectiveness of the two modes of Alflutop introduction is demonstrated subject to good tolerance of the drug. Ability of Alflutop to supress the mediators of inflammation, such as interleukins 6 and 8, and degradations at osteoarthritis, as well as to stimulate the proliferation and renewal of chondrocytes is shown according to the results of an international experimental study, explaining its ability to cause a quick analgesic and anti-inflammatory effect. Alflutop inhibits in vitro extracellular release of the pro-inflammatory cytokine interleukin 6 (IL-6) for 16 per cent and chemokine IL-8 for 35 per cent, inhibits pro-angiogenic factor VEGF for 56 per cent, has an antioxidant effect, which contributes to the synthesis of cartilage macromolecules, a decrease in the activity of matrix metalloproteases (MMPs), a decrease in the concentration of prostaglandins and leukotrienes, and a decrease in chondrocyte apoptosis. The data on the effectiveness of the Alflutop injection course in case of damage to the periaticular tissues in the shoulder, elbow, knee joint is given. The data on the gastroprotective effect of the drug, demonstrated in experimental and clinical studies is given.