Strategy for the management of osteoarthritis in multimorbid patients: the balance of effectiveness and safety while choosing drug therapy

Abstract

Due to the increase in life expectancy, the number of elderly and senile people with various chronic diseases is growing. One of the most common diseases of the musculoskeletal system is osteoarthritis. According to existing recommendations among all medications the leading place in the treatment of patients with osteoarthritis is given to symptomatic slowacting drugs (SYSADOA). Data from numerous studies show that these patients are often multimorbid, and this fact significantly restricts the appointment of many medications. In such cases, the use of drugs from the SYSADOA group becomes the basis of therapy due to their safety. Medications of this group include chondroitin sulfate and glucosamine sulfate. They are the main structural components of cartilage and synovial fluid and they are used for the synthesis of glycosaminoglycans, they reduce the degradation of cartilage, and also exhibit analgesic and anti-inflammatory effects. In addition, a number of other pleiotropic effects of these drugs have been shown, including a positive effect on muscles in sarcopenia, on reducing the risk of death from several cancers and complications of diabetes mellitus. In recent years, there has also been evidence of the use of the natural egg membrane preparation (NEM), which contains natural glycosaminoglycans and proteins necessary for maintaining the condition of the cartilage and synovial membrane. Studies have shown its anti-inflammatory effect, reducing the intensity of pain and improving functional indicators in patients with osteoarthritis. There was also a decrease in the production of pro-inflammatory cytokines in osteoarthritis for the plant-derived substance harpagophytum, which has therapeutic potential in the treatment of diseases associated with inflammation and oxidative stress.