Symptomatic Slow-acting Drugs For Osteoarthritis Research Articles

Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis.

This study was aimed to assess the efficacy and safety of two oral Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOAs)-Glucosamine Sulfate, Chondroitin Sulfate, and their combination regimen in the management of knee osteoarthritis (KOA). This systematic review was conducted according to PRISMA 2020 guidelines. A detailed literature search was performed from 03/1994 to 31/12/2022 using various electronic databases including PubMed, Embase, Cochrane Library, and Google Scholar, using the search terms-Glucosamine sulfate (GS), Chondroitin sulfate (CS), Knee osteoarthritis, Joint pain, Joint disease, and Joint structure, for literature concerning glucosamine, chondroitin, and their combination in knee osteoarthritis treatment. Cochrane Collaboration's Risk assessment tool (version 5.4.1) was used for assessing the risk of bias and the quality of the literature. The data was extracted from the included studies and subjected to statistical analysis to determine the beneficial effect of Glucosamine Sulfate, Chondroitin Sulfate, and their combination. Twenty-five randomized controlled trials (RCTs) were included in this systematic review. In short, exclusively 9 RCTs for GS, 13 RCTs for CS, and 3 RCTs for the combination of GS and CS. All these studies had their treatment groups compared with placebo. In the meta-analysis, CS showed a significant reduction in pain intensity, and improved physical function compared to the placebo; GS showed a significant reduction in tibiofemoral joint space narrowing. While the combination of GS and CS showed neither a reduction in pain intensity, nor any improvement in the physical function. However, the combinationexhibited a non-significant reduction in joint space narrowing. In the safety evaluation, both CS and GS have shown good safety profile and were well tolerated. This meta-analysis revealed that the CS (with decreased pain intensity and improvement in the physical function), and GS (with significant reduction in the joint space narrowing) have significant therapeutic benefits. However, their combination did not significantly improve the symptoms or modify the disease. This may be due to the limited trials that are available on the combination of the sulfate forms of the intervention. Hence, there is a scope for conducting multicentric randomised controlled trials to evaluate and conclude the therapeutic role of CS and GS combination in the management of KOA.

The use of symptomatic slow-acting drugs for osteoarthritis of the joints of the hands: Accent on microcirculation parameters

The aim of the study – to evaluate the effectiveness of the drug Alflutop (bioactive concentrate of small marine fish), as well as its effect on microcirculation parameters in patients with osteoarthritis (OA) of small joints of the hands.Patients and methods. The study included 80 patients aged 35 to 65 years with OA of small joints of the hands, stage I– II according to Kellgren – Lawrence, with pain ≥40 mm and ≤90 mm on a visual analogue scale (VAS). Subjects were distributed in 1:1 ratio. In the study group (combined therapy) patients received Alflutop according to the standard scheme: 2 ml intramuscularly every other day N 10 and meloxicam 7.5–15 mg per day in the “on demand” mode. The second group (monotherapy) received meloxicam 7.5–15 mg per day N 20. During the observation, the dynamics of joint pain on the VAS scale, the dynamics of the disease on the VAS scale by the patient and the doctor, the functional Dreiser index and AUSCAN (Australian/Canadian Osteoarthritis Hand Index), nailfold capillaroscopy (NFC) with an assessment of the number of capillaries and the number of alterations per 1 mm of the distal row of capillaries were evaluated. The duration of the study was 6 weeks.Results and discussion. By the 35th day of treatment with Alflutop in combination with meloxicam, a statistically significant decrease in pain and functional activity of the disease was found according to the VAS indices, the AUSCAN index (p<0.05) compared with the meloxicam monotherapy group. Microcirculation parameters according to NFC data in the Alflutop and meloxicam group remained stable by the end of the study (p>0.05). In meloxicam monotherapy group, by the 35th day of follow-up, there was a significant increase in the number of altered capillaries by 1 mm of the distal row of the nail (p<0.001).Thus, Alflutop demonstrates clinical efficacy in OA of the joints of the hands (reduces pain, stiffness, improves joint function). In addition, the effect of Alflutop with respect to slowing down microcirculatory disorders is not excluded.

Exploring Future Horizons in Osteoarthritis Relief: Unveiling the Potential of Slow-Acting Drugs and Innovative Medications

Introduction: 
 The existing treatment options for osteoarthritis (OA) fall short of addressing the significant challenges this disease imposes on patients in today's society. It markedly diminishes the quality of life of those affected and is one of the leading causes of disability. While conventional pharmacological interventions such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids effectively address pain, they are not intended to halt disease progression and are associated with potential health risks. Symptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOA) and innovative medications, rooted in our expanding understanding of OA pathogenesis, offer promising prospects for discovering improved treatment modalities.
 
 State of knowledge: 
 The evolving understanding of OA's etiology highlights the necessity for tailored treatments that consider distinct disease phenotypes. This review critically examines SYSADOA, specifically focusing on chondroitin sulfate, glucosamine, and avocado-soybean unsaponifiables, as agents designed to address the underlying pathology of OA. Chondroitin sulfate demonstrates potential disease-modifying effects, however with conflicting study results that underscore the extent of its efficacy. Glucosamine exhibits varying disease-modifying effects, with short-term trials demonstrating more promising outcomes in pain reduction. Avocado-soybean unsaponifiables show promise in alleviating knee OA pain, yet their impact on hip OA symptoms remains inconclusive. The review extends its scope to novel drugs with potential disease-modifying effects, exploring proteinase inhibitors, fibroblast growth factors, Wnt-signaling pathway inhibitors, senolytic agents, anti-nerve growth factor agents, and transforming growth factor-β.
 
 Conclusions: 
 Although preliminary studies indicate potential for certain novel agents, challenges and adverse effects necessitate further investigation through rigorous, high-quality research.

Modern possibilities of therapy of nonspecific pain in the lower back

Aim. To evaluate the effectiveness of combination therapy for low back pain (LBP) associated with spinal osteoarthritis (OA) using the Symptomatic Slow Acting Drugs for OsteoArthritis (SYSADOA) group drug Ambene® Bio.Materials and methods. The study included 30 patients with LBP aged 40 to 65 years. Various scales and questionnaires were used to assess the patients’ condition. All patients received Ambene® Bio 2.0 ml intramuscularly every other day for a total course of 10 injections. Some patients with severe pain continued to receive previously prescribed non-steroidal anti-inflammatory drugs (NSAIDs). After completing the course of treatment with Ambene® Bio, the overall effect of the therapy, changes in individual need for NSAIDs and the presence of adverse events were assessed.Results. All patients sought medical care due to exacerbation of chronic LBP. X-ray examination of the lumbosacral spine revealed degenerative-dystrophic changes in the vertebral-motor segments of the lumbar spine in all patients and in some patients – in the sacroiliac joints. The treatment showed positive dynamics in 27 (90 %) patients in the form of pain reduction not only in the lower back but also in peripheral joints. Of the 13 patients initially receiving NSAIDs, 7 (53.8 %) reduced the daily dose of the drug, and 3 (23.1 %) were able to stop taking NSAIDs. In 3 (23.1 %) cases, the initial NSAID dosage remained unchanged. Monotherapy with Ambene® Bio was received by 17 (56.7 %) patients. All patients expressed satisfaction with the treatment, of which 18 (60 %) rated the result as “excellent”, 7 (23.4 %) as “good” and 5 (16.6 %) as “satisfactory”.Conclusion. In all patients, therapy with Ambene® Bio, both in mono mode and in in combination with NSAIDs, had a positive effect, which was expressed in the reduction of the intensity of LBP on visual analog scale, improvement of peripheral joint function. In 7 (23.3 %) patients pain reduction was observed after the second injection of the drug (“the effect of the first dose”). In other cases the pain regressed later, but also within the course of treatment. All patients showed high adherence to therapy, which was explained by the rapid onset of the effect. The results of the study allow us to recommend Ambene® Bio for the treatment of LBP associated with spinal OA and within generalized OA, including patients with comorbid conditions.

Effects of low-dosage radiotherapy for knee osteoarthritis on the incidence of knee arthroplasty: Results of a randomized controlled trial with 9-year follow-up

The aim. To compare the incidence of knee arthroplasty in patients receiving standard treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in combination with symptomatic slow acting drugs for osteoarthritis (SYSADOA), or combination of NSAIDs and SYSADOA with low-dose radiation therapy (LDRT) in patients with stage 0–2 knee osteoarthritis (OA). Materials and methods. The article presents the results of randomized controlled study of 292 patients with confirmed knee OA according to Altman’s criteria (1991) and Kellgren – Lawrence radiographic stages 0–2 who were randomized into two groups. The control group (n = 146) received standard therapy of NSAIDs + SYSADOA. Patients of the study group (n = 146) received combination of standard therapy and LDRT up to a total dose of 4.5 Gy. The cumulative risk of knee arthroplasty was assessed using actuarial analysis and the Kaplan – Meier method. Attributable (AF) and population attributable (PAF) fractions were calculated to assess LDRT preventive potential. Results. The total observation period was 2131.2 person-years. Knee arthroplasty was performed in 4.1 % (n = 6) of patients in the study group against 7.5 % (n = 11) in the control group. The incidence density ratio was 0.60 (95% CI: 0.18–1.88), which corresponds to a risk reduction by 67 %, but the differences were not statistically significant due to the small number of cases (p = 0.340). The AF was 40 % while the PAF was 21 %. Conclusions. The use of LDRT reduces the risk of knee arthroplasty by two-thirds and has the potential to prevent 21 % cases of knee arthroplasty in patients with knee OA. A study on a larger sample is required.

Orthovoltage X-Ray Therapy Significantly Reduces Disability Risk In Knee Osteoarthritis Patients: A Decade-Long Cohort Study

Introduction — Osteoarthritis (OA) of the knee and hip joints affects 13% of the adult population in the Russian Federation. While medications can provide some relief from the pain associated with OA, they are often not enough. An alternative treatment option is orthovoltage radiation therapy (OVRT), which not only relieves pain, but can also help prevent disability. However, there is little evidence for the long-term effectiveness of OVRT. Objective — We compared the incidence of disability among patients with OA who received standard treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with the symptomatic slow-acting drugs for osteoarthritis (SYSADOA), or in combination with OVRT for knee OA in the setting of an open randomized controlled trial with long-term follow-up. Material and Methods — The sampling frame included patients with confirmed OA of the knee sensu Altman (1991), with radiographic grades of OA from 0 to 2 sensu Kellgren-Lawrence. A total of 292 patients were randomly distributed among two groups of equal sizes. The control group received combination therapy with NSAIDs and SYSADOA. In the experimental group, OVRT was additionally performed at a total dose of 4.5 Gy. Relationships between treatment regimen and time to disability were studied using actuarial analysis, Kaplan-Meier plots. Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI), as well as attributable fraction (AF) and population attributable fraction (PAF) were calculated. Results — The cumulative time at risk for disability was 2,304.9 person-years. In total, 9.5% of patients in the experimental group became disabled during the observation period vs. 17.8% in the control group. In the experimental group, the level of disability was lower (HR=0.49, 95% CI: 0.26-0.95). Differences became more pronounced after adjusting for sex, age, radiographic grade of OA, pain intensity, and duration of OA before treatment (HR=0.24, 95% CI: 0.11-0.48). AF and PAF were 49.9% and 25.8%, respectively. Conclusion — It has been shown that the introduction of OVRT in the treatment regimen can reduce the disability of patients with knee OA by almost 50%. One in four disability cases could be prevented if OVRT were used universally in the treatment of knee OA. Our results indicate that combining OVRT with standard care is a more effective approach to preventing disability in patients with knee OA than standard treatment alone.

From misconceptions to reasonable osteoarthritis patients therapy

Osteoarthritis (OA) is a painful and disabling disease that affects millions of people around the world. OA is the most common form of arthritis and is characterized by joint pain and stiffness, leading to a decrease in functional activity and loss of quality of life. Approaches to OA therapy are constantly being revised, as new molecules appear, data on drugs/molecules already in use, including data on adverse events, new randomized controlled trials results, new methods of adjunctive therapy become available. OA therapy and prevention, drugs with chondroprotective properties are prescribed according to the opinion of European experts (2019): chondroitin sulfate (CS), glucosamine sulfate (GS), diacerein, avocado soybean unsaponifiables, hyaluronic acid (HA) for intra-articular administering. Only CS and GS have proven effectiveness and the level of recommendations A1, they are included in clinical recommendations and standards of the Ministry of Health of the Russian Federation (MHRF), and international recommendations according to which CS and GS should be used for a long time (up to 6 months). The article focuses on the analysis of erroneous statements regarding the classification, composition and mechanisms of action of different drugs of this group. Differences in terminology of drug groups are given, such as: chondroprotectors, symptomatic slow acting drugs for osteoarthritis (SYSADOAs), disease-modifying osteoarthritis drugs, between which an equal sign cannot be placed. Based on the analysis, a conclusion was made about erroneous attitudes towards some SYSADOAs: 1) according to the Anatomical Therapeutic Chemical Classification, the active substances CS, GS, diacerein and HA are classified as nonsteroidal anti-inflammatory drugs due to their antiinflammatory activity; 2) quite often, drugs based on bioactive concentrate of small sea fish and glycoaminoglycan-peptide complex do not belong to SYSADOAs according to any of the existing generally recognized classifications, they do not contain a sufficient amount of active substances (CS or peptides), there is no proper level of evidence, they are not included in the recommendations of international medical communities and MHRF clinical recommendations and standards. In Russia, physicians must follow MHRF clinical guidelines and standards for OA therapy.

Comment on: The Effect of Intra-articular Hyaluronic Acid Injections and Payer Coverage on Total Knee Arthroplasty Procedures: Evidence From Large US Claims Database.

Comment on: The Effect of Intra-articular Hyaluronic Acid Injections and Payer Coverage on Total Knee Arthroplasty Procedures: Evidence From Large US Claims Database.

Functional Disability and Symptomatic Slow-Acting Drugs for Osteoarthritis in Adults with Periodontitis.

Osteoarthritis (OA) patients have decreased functional ability and restricted access to healthcare facilities and are on a spectrum of medications. These can impact their oral health. This study aims to investigate the association between periodontal disease and OA disease parameters, specifically the functional disability and the medications taken. This was a cross-sectional study on OA participants recruited from the Hospital Canselor Tuanku Mukhriz. Periodontal health parameters were obtained from an oral examination of the participants. A Health Assessment Questionnaire (HAQ) was administered to ascertain the functional status of the participants. Out of the 130 participants recruited, 71 (54.6%) had periodontitis. There was a correlation between the teeth count with OA severity, where participants with a greater Kellgren-Lawrence score had less teeth (rs = 0.204, p = 0.025). Participants with a greater degree of functional limitation also had less teeth (rs = -0.181, p = 0.039) and a higher clinical attachment loss (rs = 0.239, p = 0.006). There were no associations found between the symptomatic slow-acting drugs in OA and periodontal health parameters. In conclusion, there was a high proportion of periodontitis in patients with OA. Functional disability was associated with measures of periodontal health. It is suggested that clinicians treating OA patients consider the need for a referral for dental care when managing this group of patients.

Development of a verified osteoarthritis risk scale based on a cross-sectional study of clinical and anamnestic parameters and pharmacological anamnesis of patients

Objective: the development and verification of a scale for identifying patients at high risk of osteoarthritis (OA).Material and methods. The results of the analysis of a sample of patients aged 35–90 years from the database of the Institute of Trace Elements (n=3440), which included information on clinical and anamnestic, diagnostic parameters and pharmacotherapy of patients, including patients with OA (n=107), are presented. To analyze information about patients, modern methods of data analysis proposed within the topological theory of pattern recognition were used.Results. Based on the analysis of the sample, a 100-point scale of 27 points was developed which allows to identify patients at high risk of OA (sensitivity 88%, specificity 100%). For patients with high scores on the scale, a kind of “preemptive” prescription of symptomatic slowacting drugs for osteoarthritis (SySADOA) based on highly purified substances of chondroitin sulfate (CS) and glucosamine sulfate (GS) is promising. The evidence for CS/GS is extensive and has been reviewed previously.Conclusion. Early adoption of preventive measures (including the usage of SySADOA – CS/GS) in patients with a high score on the developed scale may reduce the risk of OA.

Back pain in young patients

Osteoarthritis (OA) of the facet joint (FJ) plays a significant genesis role of chronic lower back pain (cLBP) in 15–41%. OA FJ of lumbar spine occurs in 24–82% of younger people than 40 years. It has been shown that the ingestion of the "back pain" symptom at a young age in the subsequent (after 10–15 years) leads to the formation of cLBP, with a recurrent course, while OA FJ is noted in the overwhelming number of patients studied. An important aspect in the tactics choice of back pain in young patients treatment is the chronization prevention and pain syndrome relapses. In LBP treatment of against the background of OA FJ, it is recommended to use standard scheme therapy: at the first stage – injectable and oral nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, B vitamins, as well as injectable Symptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOA) – chondroitin sulfate (CS), glucosamine sulfate (GS), undenatured collagen II type (UC-II), as well as their combinations; at the second stage – oral SYSADOA (CS, GS, UC-II, as well as their combinations) and topical NSAIDs. SYSADOA have symptom- and structural-modifying effects. As a promising direction of OA therapy, the use of drugs with already proven efficacy containing CS, GS, in combination with a new molecule – UC II is considered.

Взгляд на остеоартрит с позиции доказательной медицины и собственного опыта

Osteoarthritis (OA) is a chronic heterogenic progressive disease involving the deterioration of the cartilage tissue within joints, bone remodeling and the development of osteophytes that cause such clinical manifestations as pain, stiffness, edema and reduced joint function. The review elucidates modern views on the pathogenesis of OA and the up-to-date approaches to its diagnostics and treatment. Today, the emphasis is made on relieving pain and improving the quality of life of patients with OA. Symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are used in OA clinical practice. The drugs of this class have beneficial effects on OA symptoms and their long-term use exerts disease-modifying action. SYSADOA are recommended for use as the first-line therapy and the treatment of choice in OA. Chondroitin sulfate (CS) is considered as a SYSADOA drug whose effectiveness has been proven in multiple clinical trials. CS is included in the EULAR recommendations for the treatment of patients with OA. The use of chondroitin has been shown to reduce pain and improve mobility of the affected joints. The authors present a clinical report of CS beneficial effects in a patient with OA. KEYWORDS: osteoarthritis, pathogenesis, treatment, quality of life, SYSADOA, chondroitin sulfate. FOR CITATION: Zhugrova E.S., Belyaeva I.B., Samigullina R.R. Insights in osteoarthritis from the perspectives of evidence-based medicine and authors' own experience. Russian Medical Inquiry. 2023;7(3):167–173 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-167-173.

Biomonitoring the skeletal muscle metabolic dysfunction in knee osteoarthritis in older adults: Is Jumpstart Nutrition® Supplementation effective?

This study aimedto investigate the efficacy of Jumpstart Nutrition® dietary supplement (JNDS) for enhancing the skeletal muscle metabolism and function of older adults with knee osteoarthritis (KOA) by evaluating the biomarkers of aberrant levels of serum tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), C-reactive protein (CRP), creatine kinase-muscle (CK-MM), and aldolase-A (Aldo-A). This twelve-week registry included 54 patients treated with JNDS mainly comprised of calcium, phosphorus, vitamin-K2, coenzyme-Q10, boswellic acid, and curcumin mixed with soy and whey protein (experimental group) and 51 patients treated with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) (control group) for KOA confirmed with radiological images. At week 0 and week 12 for both the groups evaluated, the non-fasting serum levels of TNF-α, IL-10, CRP, CK-MM, and Aldo-A by using appropriate kits. At week-twelve, the respective values of area under the ROC curves of the studied biomarkers for pooled experimental cohorts were 0.928, 0.907, 0.908, 0.927, and 0.988 having the significance of accuracy (R-square):66.28%, 47.25%, 70.39%, 65.13%, and 68.00%, indicating a satisfactory treatment policy, their mean± SD, and risk ratio, all exhibited highly significant differences (p<0.0001) and KOA-gradation was upgraded between≥2 and ≥3 from≥4 as per the Kellgren-Lawrence scale compared to the control. Fewer patients had to use emergency medications (p<0.05). Results suggest that JNDS may be effectively used to strengthen the skeletal muscle metabolismand function of elderly patients with KOA confirmed with the stabilization of studied biomarkers as an alternative to the treatment of SYSAD correlated with ROC curves and the Kellgren-Lawrence scale.

Current Management Strategy for Osteoarthritis Patients: a Review

A strategic approach is crucial to the management of patients with osteoarthritis (OA). It should be based on the current understanding of the pathogenesis of OA as an inflammatory disease. A review of current clinical guidelines for the management of patients with OA shows significant differences in the evaluation of pharmacological approach, especially the place of symptomatic slow-acting drugs for osteoarthritis, (SYSADOA) and a certain consensus in relation to non-pharmacological methods (primarily exercise, patient education, body weight control, various physiotherapy methods, orthotics and massage/manual therapy). It should also be taken into account the international “treat to target” recommendations, the main idea of which is careful regular monitoring of the patient’s condition and adaptation of treatment tactics depending on the response to treatment. Based on the analysis of literature data and their own clinical experience, the authors developed an algorithm for the strategy of complex therapy of OA, including the following steps: 1) pain control (2-4 weeks), 2) inflammation control (4-6 weeks); 3) control over cartilage degradation (6 weeks – 12 months). For each stage, a specific combination of systemic pharmacotherapy (non-steroidal anti-inflammatory drugs, SYSADOA), intra-articular administration of glucocorticoids and hyaluronic acid, exercises and magnetotherapy (pulsed electromagnetic field) was proposed. A staged comprehensive strategy for the treatment of patients with OA should help to achieve control over the symptoms, while minimizing the duration of NSAIDs and avoiding polypharmacy, and further achievement of inhibition of structural progression.

Multimodal Multidisciplinary Management of Patients with Moderate to Severe Pain in Knee Osteoarthritis: A Need to Meet Patient Expectations.

Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.

Chronic back pain as a spinal osteoarthritis manifestation: rationale and practice of symptomatic slow acting drugs for osteoarthritis use

Chronic non-specific back pain (CNBP) is the most common pathology of the musculoskeletal system, affecting from 10 to 60% of the adult population in the world, causing severe suffering, disability and a significant deterioration in the quality of life. Osteoarthritis (OA) should be considered as one of the main reasons of the development of CNBP – inflammatory and degenerative changes in the facet and sacroiliac joints, as well as the spinal column itself (in particular, osteitis of the Modic 1 type). Spinal OA is accompanied by biomechanical disturbances, nociplastic (peripheral and central sensitization) and psycho-emotional changes that form a complete picture and various CNBP phenotypes.Recognizing the leading role of OA as the cause of CNBP, it is advisable to use the same therapeutic approaches in this syndrome as in OA of peripheral joints. In particular, it is necessary to consider the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) in CNBP as the main pathogenetic therapy.Alflutop is one of the most popular parenteral SYSADOA widely used in Russian practice. This drug has a good evidence base: this review presents data from 12 clinical trials of Alflutop in CNBP (n=1479), which confirmed its efficacy and safety.

Evidence-based therapy for knee osteoarthritis: expected short-, medium-, and long-term outcomes of prescription crystalline glucosamine sulfate administration

The need for effective drugs for the treatment of knee osteoarthritis (OA) is constantly growing. Current guidelines recommend the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) such as glucosamine (GCA) in this disease. Among various drugs containing GCA, high bioavailability and clinical efficacy have been shown only for prescription crystalline GCA sulfate (pGCAS) administration. Several meta-analyses and network meta-analyses have shown that efficacy of pGCAS 1500 mg once daily is superior to other GCA-based products (such as GCA hydrochloride with or without sodium sulfate) and the combination of GCA with chondroitin sulfate (CS) in terms of reducing the intensity of pain and improving the functional state. These studies confirmed the favorable safety profile of pGCAS, which was comparable to placebo in the incidence of adverse events. Pharmacoeconomic studies have also demonstrated greater cost-effectiveness of pGCAS compared to other GCA drugs.A group of Russian experts at a meeting of the advisory committee reviewed the evidence in favor of the use of pGCAS and evidence of its effectiveness in the treatment of knee OA in comparison with other products that include GCA, and the fixed combination of GCA with CS. Taking into account the results obtained, the use of pGCAS at a dose of 1500 mg once a day is recommended as a rational choice for the treatment of knee OA.

Osteoarthritis of the knee - biochemical aspect of applied therapies: a review.

The most prevalent form of arthritis is osteoarthritis (OA) of the knee, which is characterized by a degeneration of articular cartilage resulting in the development of osteophytes, or bone spurs. Main goals of OA treatment are to reduce pain, slow the disease progression, and improve joint function and the quality of life. The purpose of this study was to verify all the therapies recommended by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) from the biochemical point of view. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of eicosanoids, whereas paracetamol prevents the production of prostaglandin (PG) by interacting with peroxidase (POX) site of the prostaglandin H2 synthase complex. Tramadol is an opioid that has a dual mechanism of action: It binds to the μ-opioid receptor and it inhibits serotonin and adrenaline. Corticosteroids, which are also prescribed for OA pain, inhibit the activity of phospholipase A2 and block the synthesis of arachidonate-derived eicosanoids. Symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are drugs that are well tolerated by patients and help to restore proteoglycan matrix of the cartilage. These drugs include compounds that naturally build articular cartilage. The articular cartilage, as well as the bone located around the cartilage, is destroyed as osteoarthritis progresses. Thus, bisphosphonates, commonly used in the treatment of osteoporosis, were evaluated as potential therapy. However, there is no official recommendation for their use in therapy. The aim of the study was to analyze the biochemical mechanisms of principal drugs used for the treatment of knee OA. Therefore, a narrative review summarizing the current knowledge regarding the applied therapies was prepared.

Эффективность неденатурированного и гидролизованного коллагена II типа в терапии болевого синдрома

Collagens play an important structural role and contribute to the mechanical properties, organization and shape of tissues. In musculoskeletal system diseases (MSD), the amount of type II collagen in the cartilage extracellular matrix significantly decreases. Degradation and reduction of type II collagen are associated with osteoarthritis (OA). At present, SYSADOA (Symptomatic Slow Acting Drugs for Osteoarthritis) are widely used in the treatment of OA for oral and parenteral use. Besides, increased attention has been paid to the new treatment methods for OA based on a new promising type II collagen molecule: undenatured (UC-II) and hydrolyzed (HC-II) collagen. UC-II is a native collagen (fibrillar protein with a molecular weight of 300 kDa), whereas HC-II is a polypeptide (molecular weight of 2–9 kDa). The article describes the molecular mechanisms of action of UC-II and HC-II, and identifies the main differences between them. The diverse mechanism of action of the described collagen types determines their clinical use: UC-II is prescribed mainly in MSD, in particular OA, and HC-II is mainly used in cosmetology, as well as in MSD. The article also presents the study results demonstrating the safety and efficacy of drugs and dietary supplements containing UC-II and HC-II in relieving pain syndrome during OA. KEYWORDS: undenatured type II collagen native collagen, hydrolyzed collagen, collagen peptides, SYSADOA, pain syndrome, osteoarthritis. FOR CITATION: Shavlovskaya O.A., Bokova I.A., Romanov I.D., Shavlovsky N.I. Efficacy of undenatured and hydrolyzed type II collagen in the treatment of pain syndrome. Russian Medical Inquiry. 2022;6(10):571–575 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-571-575.

Complex effects of physical exertion with dietary supplements Cartilox in pain syndrome effectiveness and safety evaluation

To Identify the effect of physical activity complex effects with dietary supplements Cartilox (composition: hydrolyzed type II collagen, hyaluronic acid, boswellia, curcumin, piperine) on the severity of pain syndrome in OA knee and hip joint patients, low back pain (LBP); assessment of the need for the appointment of NSAIDs against the background of taking Cartilox. The study included 60 patients aged 35-65 years, with a confirmed diagnosis of knee and hip OA I-II st., LBP with a slight degree of severity of pain syndrome - 4-5 points on a numerical rating scale (NRS). Patients with comorbid diseases: arterial hypertension (AH), type 2 diabetes mellitus (DM-2), hypothyroidism, diseases of the gastrointestinal tract (gastrointestinal tract). By randomization, the patients were divided into two groups: Main group (n=30; 54.36±8.57 years) received a complex effect of non-drug therapy (physical therapy complex) with dietary supplements Cartilox 1 sachet per day during or immediately after meals for 1 month, in combination with non-medical therapy (physical therapy complex). And Control group (n=30; 53.03±16.18 years) used only non-medical therapy (physical therapy complex). In both groups, topical NSAIDs were used «on demand». The patients included in the study had imaging data of the spine and joints. Clinical and neurological examination was used: day 0 (Visit 1), Day 14 (Visit 2), Day 30 (Visit 3) of therapy. The dynamics of the condition was assessed: 10-point NRS of pain assessment (at rest, while walking, palpation), functional status of Oswestry Disability Index (ODI), blood pressure (BP) was measured, the dynamics of biochemical parameters (before and after 30 days) of blood glucose, liver enzymes (AST, ALT), weight indicators, registration of adverse events (AEs). A sub-objective assessment (1 to 5 balls) was given to the patient and the physician. Against the background of taking Cartilox, a statistically significant decrease in the severity of pain syndrome was noted, an improvement on ODI (to a greater extent in the Main group vs the Control group). In no case has a registered AEs. Changes in the level of biochemical blood parameters (glucose, liver enzymes) and blood pressure levels were not observed. The topical NSAIDs use was observed only in the Control group. The complex effect of physical exertion with dietary supplements Cartilox can be recommended for patients with unexpressed pain syndrome (4-5 points on the NRS) with LBP and knee and hip OA (I-II st.). The absence of changes in the level of biochemical parameters of blood and blood pressure makes it possible to recommend Cartilox to patients with OA and comorbid diseases.