The effect of different treatments on the clinical course of knee osteoarthritis

Abstract

Purpose: To study the effect of different groups of drugs on the clinical course of gonarthrosis as well as to develop an algorithm for selection of therapeutic approach depending on clinical and radiation signs of this disease. Methods: 122 patients with unilateral knee osteoarthritis in the age of 30-70 years old were examined. The patients were randomized in 4 groups comparable by age, BMI and clinical and radiation signs. Patients of the first group (n = 30) received chondroitin sulfate 1,200 mg/day and glucosamine 1,500 mg/day (Theraflex®). The second group (n = 31) received chondroitin sulfate 1,200 mg/day and glucosamine 1,500 mg/day in combination with oral strontium ranelate 2 g a day. The third group (n = 30) – chondroitin sulfate 1,200 mg/day and glucosamine 1,500 mg/day in combination with oral diacerein 50 mg twice a day. The fourth group (n = 31) – chondroitin sulfate 1,200 mg/day and glucosamine 1,500 mg/day in combination with intra-articular administration of 1.5% sodium hyaluronate 2.0 ml No. 4 courses per course with interval of 7 days. Duration of oral therapy was 12 months (Fig. 1). The diagnosis of osteoarthrosis was established in accordance with American College of Rheumatology criteria. Roentgenological stage was assessed in accordance with Kellgren and Lawrence classification. At randomization roentgenologic stage I was registered in 79 patients (64.75 %), stage II – in 43 (32.25 %). All study participants were examined by three times: before treatment and after 6 and 12 months of treatment. Magnetic Resonance Imaging (MRI, 3 Tesla) with colour mapping of the knee cartilage tissue and calculation of T2-reaxation time were performed. The patients assessed degree of pain syndrome and disease course by 100-point Visual Analogue Scale (VAS); functional activity of joints was determined by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (Fig.2). Results: This is the first study conducted with the use of MRI with colour T2-mapping of the cartilage to verify structural changes of the knee cartilage in early stages of osteoarthritis in dynamics. It was established that both bone marrow edema (osteitis) and decrease of bindings between collagen-proteoglycan complex and water molecules which is reflected by such critical parameter as the change of T2-signal relaxation time detected using T2-mapping method play a special role in this stage of the disease (Fig. 1).Fig. 2Dynamics of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in study groups at baseline and after 6 and 12 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Conclusions: It was established that both bone marrow edema (osteitis) and decrease of bindings between collagen-proteoglycan complex and water molecules which is reflected by such critical parameter as the change of T2-signal relaxation time detected using T2-mapping method play a special role in this stage of the disease. Combination of oral CS and G (Theraflex®) and intra-articular administration of sodium hyaluronate was the most effective in treatment of knee osteoarthritis.