Modern pharmacotherapy for post-traumatic osteoarthritis

DOI: https://doi.org/10.29296/25877305-2022-12-10
Issue: 
12
Year: 
2022

A. Povzun(1, 2); V. Kostenko(1), K. Povzun(1), E. Shmeleva(1), I. Sarvilina(3)
1-I.I. Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine
2-Acad. I.P. Pavlov First Saint Petersburg State Medical University
3-OOO “Novomeditsina” Medical Center, Rostov-on-Don

The strategy and tactics for using the drugs that affect the pathobiochemical pathways of inflammation and structural changes in cartilage and synovial tissues in joint functional impairment (JFI) during post-traumatic osteoarthritis (PTOA) are an urgent public health problem. Objective. To study the mechanism of action of and to evaluate the efficacy of parenteral chondroitin sulfate (CS; Chondroguard®, CS-Bioactive© Bioiberica S.A.U., Spain; ZAO Sotex PharmFirm, Russia) in patients with Stage 1 PTOA of the knee and grade 1 JFI. Subjects and methods. A 50-day open-label prospective controlled randomized study was conducted. The study involved 64 patients with Kellgren-Lawrence X-Ray Stage I PTOA of the knee and grade 1 JFI, who were divided into 2 groups. Group 1 included 34 patients who received CS (Chondroguard®, 100 mg/ml) intramuscularly every other day; the first 3 injections were 1 ml each, with a good tolerance; the each dose of the 4th to 25th injections was 2 ml; the treatment cycle was 50 days) and meloxicam (Amelotex®, 15 mg/day); Group 2 consisted of 30 patients who took meloxicam (Amelotex®, 15 mg/day that could be reduced 7.5 mg/day and be discontinued). On study days 0 and 50, the patients underwent assessment of pain intensity using the visual analogue scale (VAS) and the WOMAC index, the functional state of the knee joint and the activity in daily life and active sports life by the Lequesne index; the safety of therapy was evaluated by the WHO and Naranjo scales; standard radiography and MRI of the knee were done evaluating the articular cartilage and calculating the T2 relaxation time. Laboratory testing for blood biomarkers included the determination of the concentration of ultrasensitive C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL)-1β and IL-6. The data were statistically processed using the Statistica 10.0 program (StatSoft, Inc., USA). Results. CS therapy was well tolerated by patients and was accompanied by a considerable improvement in the pain intensity at rest and during movement according to the VAS (U test=7.79; p
Keywords: 
therapy
post-traumatic osteoarthritis
knee joint
pain
functional impairment
cartilage tissue
chondroitin sulfate
Chondroguard®.

References: 
  1. Russian clinical guidelines. Rheumatology. Ed. E.L. Nasonov. M.: GEOTAR-Media, 2017 (in Russ.).
  2. Udartsev E.Yu. The role of inflammation in pathogenesis of posttraumatic osteoarthritis. Cytokines and Inflammation = Tsitokiny i vospalenie. 2011; 10 (3): 82–7 (in Russ.).
  3. Golovach I.Yu., Zazirnyi I.M., Semeniv I.P. Posttraumatic osteoarthritis: inflammatory, cellular and biomechanical mechanisms of disease progression (review). Travma. 2016; 17 (1): 99–105 (in Russ.).
  4. Korochina K.V., Chernysheva T.V., Polyakova V.S. et al. Features of morphology of articular cartilage in patients with different phenotypes of knee osteoarthritis. Archive of Pathology = Arkhiv patologii. 2020; 82 (4): 13–8 (in Russ.). DOI: 10.17116/patol20208204113
  5. Sarvilina I.V., Shavlovskaya O.A., Gromova O.A. et al. Modern achievements in pharmacotherapy of osteoarthritis based on endo- and phenotyping. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2021; 14 (3): 379–406 (in Russ.). DOI: 10.17749/2070-4909/farmakoekonomika.2021.105
  6. Lila A.M., Tkacheva O.N., Naumov A.V. et al. Place and role of the parenteral form of chondroitin sulfate in the treatment of osteoarthritis: multidisciplinary Consensus. RMJ. 2021; 6: 68–74 (in Russ.).
  7. Karateev A.E., Nasonov E.L., Ivashkin V.T. et al. Rational use of nonsteroidal anti-inflammatory drugs. clinical guidelines. Rheumatology Science and Practice. 2018; 56: 1–29 (in Russ.). DOI: 10.14412/1995-4484-2018-1-29
  8. Alekseeva L.I., Sharapova E.P., Kashevarova N.G. et al. Comparative study of the efficacy and safety of Chondroguard® during its combined (intra-articular and intramuscular) and intramuscular injection in patients with knee osteoarthritis. Modern Rheumatology Journal. 2018; 12 (2): 44–9 (in Russ.). DOI: 10.14412/1996-7012-2018-2-44-49
  9. Rivera F., Bertignone L., Grandi G. et al. Effectiveness of intra-articular injections of sodium hyaluronate-chondroitin sulfate in knee osteoarthritis: a multicenter prospective study. J Orthop Traumatol. 2016; 17 (1): 27–33. DOI: 10.1007/s10195-015-0388-1
  10. Gonartroz. Klinicheskie rekomendatsii (in Russ.). URL: https://cr.minzdrav.gov.ru/recomend/667_1
  11. Singh J.A., Noorbaloochi S., MacDonald R., Maxwell L.J. Chondroitin for osteoarthritis. Cochrane Database Syst Rev. 2015; 1 (1): CD005614. DOI: 10.1002/14651858.cd005614.pub2.
  12. Torshin I.Yu., Lila A.M., Naumov A.V. et al. Meta-analysis of clinical trials of osteoarthritis treatment effectiveness with Chondroguard. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2020; 13 (4): 388–99 (in Russ.). DOI: 10.17749/2070-4909/farmakoekonomika.2020.066
  13. Reginster J.-Y., Veronese N. Highly purified chondroitin sulfate: a literature review on clinical efficacy and pharmacoeconomic aspects in osteoarthritis treatment. Aging Clin Exp Res. 2021; 33 (1): 37–47. DOI: 10.1007/s40520-020-01643-8
  14. Voloshin V.P., Eryomin A.V., Sankaranarayanan S.A. et al. Study on Effectiveness of Hondrogard (Chondroitin Sulfate) in Patients with Osteoarthritis. Trudnyi patsient. 2015; 13 (3): 2932 (in Russ.).
  15. Lila A.M., Gromova O.A., Torshin I.Yu. et al. Molecular effects of chondroguard in osteoarthritis and herniated discs. Neurology, Neuropsychiatry, Psychosomatics. 2017; 9 (3): 88–97 (in Russ.). DOI: 10.14412/2074-2711-2017-3-88-97
  16. Honvo G., Bruyère O., Reginster J.Y. Update on the role of pharmaceutical-grade chondroitin sulfate in the symptomatic management of knee osteoarthritis. Aging Clin Exp Res. 2019; 31 (8): 1163–7. DOI: 10.1007/s40520-019-01253-z
  17. Nguyen J., Liu F., Blankenbaker D. et al. Juvenile osteochondritis dissecans: cartilage T2 mapping of stable medial femoral condyle lesions. Radiology. 2018; 288 (2): 536–43. DOI: 10.1148/radiol.2018171995
  18. Alekseeva L.I. Preparaty zamedlennogo deistviya v lechenii OA. RMJ. 2012; 7: 389–93 (in Russ.).
  19. Martel-Pelletier J., Raynauld J.-P., Mineau F. et al. Levels of serum biomarkers from a two year multicentre trial are associated with treatment response on knee osteoarthritis cartilage loss as assessed by magnetic resonance imaging: an exploratory study. Arthritis Res Ther. 2017; 19: 169. DOI: 10.1186/s13075-017-1377-y
  20. Mertens M., Singh J. Biomarkers in Arthroplasty: A Systematic Review. Open Orthop J. 2011; 5: 92–105. DOI: 10.2174/1874325001105010092
  21. Vincent T.L. IL-1 in osteoarthritis: time for a critical review of the literature. F1000Research. 2019; 8 (F1000 Faculty Rev): 934. DOI: 10.12688/f1000research.18831.1
  22. Wang W., Kang W., Tang Q. et al. Cilostazol prevents the degradation of collagen Type II in human chondrocytes. Biochem Biophys Res Commun. 2014; 451 (3): 352–5. DOI: 10.1016/j.bbrc.2014.07.058
  23. Miller R.E., Miller R.J., Malfait A.M. Osteoarthritis joint pain: the cytokine connection. Cytokine. 2014; 70 (2): 185–93. DOI: 10.1016/j.cyto.2014.06.019