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

Objective: to evaluate the effectiveness of therapy with AMBENE®Bio (AB) in comparison with the comparator drug (bioactive concentrate of small marine fish, BCSMF) in patients with osteoarthritis (OA) of large and small joints in routine clinical practice.Patients and methods. KOLIBRI multicenter, observational, non-randomized, comparative study included 233 patients with OA of the small hand joints (HJ) or knee joints (KJ) from three Russian centers (two in Moscow and one in Tula). Patients with a generalized form of OA were excluded from the analysis. The remaining patients were divided into two groups depending on the localization of OA. The first group included 174 patients with knee OA, 105 of them received AB, and 69 received the reference drug (BCSMF) according to the same regimen. The second group consisted of 21 women with HJ OA: 13 patients were prescribed AB, and 8 — the reference drug.The duration of the study averaged 330±14 days, the total number of visits was 4. The main indicator of effectiveness was the dynamics of pain during movement according to VAS (0—100 mm) 30±7 days after the start of treatment compared with the baseline value. All patients underwent radiography of the HJ and KJ, as well as ultrasound of the involved joints.Results and discussion. Both drugs provided significant clinical improvement in patients with OA, which is consistent with other studies with similar design and long follow-up. These data confirm the symptom-modifying properties of the presented group of combined drugs in the OA treatment. The Russian injectable drug AB in OA was not inferior in effectiveness to the foreign BCSMF. According to the OMERACT-OARSI criteria, 85.2% and 88.9% of patients, respectively, responded to treatment with AB and the reference drug. In both groups, half of the patients managed to stop further use of non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis.Conclusion. The use of AB was accompanied not only by a decrease in the severity of clinical symptoms of OA, but also by a decrease in the daily requirement for NSAIDs almost by 2 times.

Post hoc analysis of the results of KOLIBRI comparative observational clinical study in patients with knee and small hand joints osteoarthritis

Феклистов¹,

Vorobieva²,

Alekseeva³

et al. 2022

Treatment of rheumatic diseases. Different nosologies, common problems

Olyunin¹

2023

A characteristic feature of rheumatic diseases (RD) is a chronic inflammatory process, which contribute to their pathogenesis, and determines the formation of a persistent pain syndrome. Therefore, in current recommendations for the treatment of RD, the main attention is paid to the correction of disorders that induce pain caused by inflammation. Meanwhile, more and more data are accumulating on the participation of noninflammatory mechanisms in the development of pain in RD. In some cases, the clinical picture of RD is determined by the simultaneous participation of several mechanisms. At the same time, the symptoms associated with the inflammatory process can eventually transform into a different pain phenotype, which persists even after the suppression of inflammatory changes. In such a situation, a correct assessment of the patient's status can cause serious difficulties. The results of the studies show that in everyday clinical practice, when assessing the status of a patient, in addition to the disorders characteristic of each disease, it is necessary to take into account the possibility of the presence of symptoms due to the mechanisms of central sensitization common to various joint diseases.

Alflutop Russian longitudinal multicenter observational study: use in patients with chronic back pain (message 3)

Lila,

Karateev,

Alexeeva

et al. 2024

The use of slow-acting disease-modifying symptomatic drugs, such as bioactive concentrate from small marine fish (BCSMF, Alflutop), is considered a potential element of complex therapy for chronic non-specific back pain (CNBP).Objective: to evaluate the efficacy of the BCSMF in patients with CNBP in real-life clinical practice.Material and methods. An open observational study included 10,047 patients with CNBP (age – 58.3±14.9 years, 58.4% women) with moderate or severe pain – 60 [50; 70] mm on the visual analogue scale (VAS). All patients received a course of BCSMF medication: 1 ml intramuscular (IM) daily No. 20 or 2 ml IM every other day No. 10. 68.8 % of patients also took non-steroidal anti-inflammatory drugs. Treatment outcomes were assessed 10 days after completion of BCSMF therapy (30 days after initiation of treatment).Results and discussion. As a treatment result, the pain intensity according to the VAS decreased from 60 [50; 70] to 20 [10; 30] mm (p<0.0001), the patients’ overall health assessment according to the VAS increased from 50 [30; 60] to 80 [60; 90] mm (p><0.0001) and the quality of life assessment (EQ-5D) – from 0.52 [0.06; 0.66] to 0.8 [0.71; 1] points (p>< 0.0001). A good response to treatment (pain reduction >50%) was observed in 73% of patients. On average, an improvement was observed on the 8th [5; 10] day of BCSMF therapy. There were no serious adverse effects associated with the use of the drug. Older age, overweight, initially more severe pain, and the presence of comorbid conditions were slightly more frequently associated with a less pronounced response to therapy.Conclusion. The use of BCSMF rapidly and effectively reduces the severity of pain and other symptoms associated with CNBP.