The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) treatment algorithm for the management of knee osteoarthritis (OA), published in December 2014, provides practical guidance for the prioritization of interventions. This current paper represents an assessment and endorsement of the algorithm by Russian experts in OA for use in Russian clinical practice, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA, in support of the clinicians’ individualized assessment of the patient. Medications recommended by the ESCEO algorithm are available in Russia. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOA) is advised, for which high-quality evidence is provided only for the formulations of patented crystalline glucosamine sulphate (pCGS) (Rottapharm/Meda) and prescription chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs but without the systemic safety concerns. To be effective, topical NSAIDs must have high bioavailability, and among NSAIDs molecules like etofenamate have high absorption and bioavailability alongside evidence for accumulation in synovial tissues. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk: benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.
The study aims to compare the methods of Mucosat drug use and administration for achieving the desired therapeutic effect in the treatment of osteoarthritis.
Despite extensive evidence base, improving complex therapy schemes for the use of successive and complementary dosage forms with the appropriate drug administration and use in order to achieve the desired therapeutic effect is still a valid aim.
In the course of the study, 50 knee osteoarthritis patients were examined and treated during the period from November, 2019 to April, 2020.
A clinical trial was carried out to assess Mucosat oral and parental administration effectiveness in the patients comparing their physical activity, functional ability and quality of life. The number of undesired side effects identified the degree of therapeutic tolerance against the comorbid diseases identified. A comparison of the therapeutic efficacy and tolerability of Musocat intramuscular and capsule administration, patient compliance, the need to take non-steroidal anti-inflammatory drugs (NSAIDs) was drawn.
Statistica 12 and Excel 2016 were used to carry out the statistical analysis of the data obtained. The study was generally marked by diagnostic accuracy with the use of modern methods, group homogeneity, prospective observational design.
By the time of pharmacotherapy completion, physical activity has become optimal in the study groups. However, parental therapy had significantly higher effectiveness than the oral one on all the subscales. As a result, articular syndrome severity has been reduced and the functional state of the joints expanded.
The study has shown that Mucosat demonstrates high efficacy both in injectable solution and capsule dosage forms as a basic chondroprotective drug. Mucosat pharmacotherapy course has contributed to permanent discontinuation of NSAIDs before completion of the therapy. The superiority of Mucosat parenteral administration over the oral one has been proven.
The article is devoted to third-generation slow-modifying chondroprotective drug therapy including Alflutop. The evidence-based medicine showed and substantiated in vitro effect of the drug on the pathogenetic processes in the cartilage tissue, its promotion of the inflammation regression in the musculoskeletal system. The authors present a series of clinical studies of top osteoarthritis doctors, which showed that Alflutop had an anti-inflammatory, chondroprotective, analgesic effect, and that the administration of the drug allowed patients to reduce the doses of NSAIDs, and it could be used in patients with comorbid diseases.
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