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Forty women with gonarthrosis were included in this study. The main group consisted of 19 patients having osteoarthritis (OA) with metabolic syndrome (MS), the control group consisted of 21 patients with OA but without MS. It was found that metabolic phenotype of gonarthrosis, i.e. OA with concomitant MS, was different from OA without MS in terms of pain measured with visual analogue scale (VAS) (65 mm in the main group vs 47 mm in control group, р = 0.001) and other OA symptoms in accordance with Knee Osteoarthritis Outcome Scale (KOOS) (43.2 points in the main group vs 76.1 points in the control group, р = 0.001). These main distinguishing features were associated with low quality of life measured with non-specific questionnaire Short Form -36 (SF-36) (30 points in the main group and 40 points in the control) and clinically significant signs of depression, detected with Patient Health Questionnaire-9 (PHQ-9) (12 points in the main group and 7 points in the control group). The metabolic phenotype of gonarthrosis was characterized with laboratory features of low-grade systemic inflammation as evidenced by increased CRP (11.4 mg/ml in the main group vs 3.2 mg/ml in the control group, р = 0.03), IL-6 (2.6 pg/ml in the main group vs 0.7 pg/ml in the control group, р = 0.001), IL-18 (196.6 pg/ml in the main group vs 61.4 pg/ml in the control group, р = 0.001) in the peripheral blood serum, as well as increase in antibodies against Col2 (27.1 ng/ml in the main vs 5.5 ng/ml in the control group, р = 0.01) , and dyslipidaemia — increase in LDL-cholesterol (5.5 mmol/l in the main group vs 5.9 mmol/l in the control group, р = 0.032) and triglycerides (2.026 mmol/l in the main group and 1.36 mmol/l in the control gropu, р = 0.02). In conclusion, MS-associated OA phenotype occurs due to pathogenetic similarities between OA and MS (syntropy) based on systemic low grade inflammation. This OA phenotype is not well studied and needs further research to develop new treatments targeting these two comorbid disorders as a single disease.
Treatment of osteoarthritis (OA) patients with comorbidities can be challenging due to adverse events and non-sufficient efficacy of modern drugs. A safe and effective alternative could be the methods of traditional medicine and their combinations. The aim of this study was to evaluate efficacy and safety of combination of curcuma-based parapharmaceutical preparation and acupuncture in metabolic phenotype of OA (MPOA). The trial design was pilot open-label “before – after” study with the duration of 12 weeks. The patients with MPOA received parapharmaceutical preparation Epigenorm Antivir in a daily dose of 1000 mg and underwent 15-20 sessions of classical acupuncture. We enrolled twenty three women with metabolic syndrome (MS), clinical and radiographic signs of gonarthrosis, mean age 66.5 years, mean body mass index 34.5. At the end of treatment there was a decrease in pain levels according to visual analogue scale (VAS) (before 65 (12.7), after 24.6 (21.0), р=0.001), WOMAC pain scale (before 210.6 (102.2), after 103 (80.8), p = 0.014), KOOS (before 47.8 (12.1), after 66.7 (16.2), р = 0.001). The treatment resulted in statistically significant improvement of daily and social activities, role functioning, and quality of life. The results were clinically significant as evidenced by the moderate (Cohen d > 0.5) and large (Cohen d > 0.8) effect sizes of most outcome changes in accordance with the Cohen classification. The clinical improvement was accompanied by the decrease in MS components – LDL cholesterol (before 3.26 (0.26) mmol/l, after 2.43 (0.2) mmol/l, р = 0.001), triglycerides (before 2.02 (0.16) mmol/l, after 1.31 (0.1) mmol/l, р = 0.005). The treatment resulted in the reduction of systemic inflammation as evidenced by the decrease in the concentrations of TNFα (before 15.9 (1.2) pg/ml, after 12.4 (0.8), р = 0.002), histamine (before 1.6 (0.2) ng/ml, after 0.7 (0.2) pg/ml, р = 0.034), IL-18 (before 208.8 (32.6 ) pg/ml, after 160.0 (26.0) pg/ml, р = 0.002) and CRP (before 6.05 (1.3) mg/l, after 3.2 (0.7) mg/l, р = 0.022). At the same time there was an increase of concentration of IL-10 (before 1.5 (0.7) pg/ml, after 3.8 (1.2), р = 0,006) and adiponectin (before 34.0 (5.6) pg/ml, after 40.0 (6.9), р = 0.034). The treatment was well tolerated, no serious adverse events were registered. The pleiotropic actions of combination treatment occured probably due to synergistic effects of herbal therapies and acupunctures. The results provide a rationale for larger scale, randomized controlled double-blind clinical trials.
The aim of this study was to assess efficacy and safety of curcumin in metabolic syndrome- associated osteoarthritis (MetS-OA). All patients provided written informed consent. Knee OA was diagnosed according to American College of Rheumatology criteria; MetS was diagnosed according to Russian Scientific Society of Cardiology Guidelines. The study had before-and-after design. The main inclusion criteria were presence of knee OA and MetS, levels of global health assessment and pain assessment more than 50 mm using 0-100 visual analogue scale (VAS). The main outcome was VAS global. The other outcomes were VAS pain, Knee injury and Osteoarthritis Outcome Score (KOOS) consisting of five subscales: pain (KOOS pain), other symptoms (KOOS symptoms), activities in daily living (KOOS ADL), function in sport and recreation (KOOS Sport/Rec) and knee related Quality of life (KOOS QoL). The level of depression was measured using PHQ- 9. For pain, proportion of patients achieving minimal clinically important improvement (MCII) was assessed using the cut-offs of (a) 15 of 100 for absolute improvement and 20% for relative improvement.The treatment consisted of C. longa extract 1000 mg/day for 4 weeks. The assessments were performed on baseline and 4 weeks thereafter. Eighteen women with MetS-OA of the knee were included in the study.At the end of treatment, there were significant improvements in the VAS global scale by an average 33.9 mm (p = 0.001), VAS pain by 25 mm (p = 0.001). There was a trend towards improvement in PHQ-9 by 2.9 (p = 0.05). The mean improvement in KOOS pain was 11 (p = 0.001). KOOS symptoms improved by 9 (p = 0.025), KOOS ADL - by 12.4 (p = 0.001), KOOS Sport/Rec by 10.3 (p = 0.044), and KOOS QOL by 14.4 (p = 0.009). The proportion of patients achieving clinically significant improvement (MCII) were nine (56%) for both global health and pain. There were no adverse events during the study. The findings of this study suggest clinical efficacy and safety of C. Longa in MetS-associated knee OA. There is a need for large controlled studies to confirm these results.
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