Expert Opinion on the Extensive Use of Prescription Crystalline Glucosamine Sulfate in the Multimodal Treatment of Osteoarthritis in Ukraine, Kazakhstan, Uzbekistan, and Armenia

Abstract

Objective: The present work was led by a multidisciplinary panel of experts and proposes an extensive review on the use of prescription crystalline glucosamine sulfate (pCGS) in the multimodal treatment of osteoarthritis (OA) applicable in Ukraine and other Commonwealth of Independent States (CIS) countries. Methods: A panel of rheumatologists, orthopedic surgeons, and field experts from Ukraine and CIS regions discussed the management of OA. Literature was systematically searched using Medline, EMBASE, CIHNAL, and Cochrane Library databases. The 2-day meeting critically reviewed the available literature, treatment algorithms, pharmacoeconomic aspects, and real-world instances to form a multimodal approach based both on real-life clinical practice and systematic literature research for the management of OA in Ukraine and CIS countries. Expert Opinion: pCGS plays a pivotal role in the stepwise approach to OA treatment. If it is necessary (step 1), the combined use of pCGS with paracetamol and topical nonsteroidal anti-inflammatory drugs (NSAIDs) has been recommended. If symptoms persist, oral NSAIDs and intra-articular (IA) hyaluronic acid or corticosteroids are added to the therapy (step 2) of pCGS in the patients. In case of insufficient relief and severe OA (step 3), pCGS along with oral NSAIDs, IA corticosteroids, and duloxetine have been recommended. Patient stratification with regular monitoring and careful alterations in treatment were advocated. Conclusions: This expert opinion article recommends a modified approach to the existing guidelines incorporating pCGS in treatment modality of OA in Ukraine and CIS countries. Extensive use of pCGS targets early symptomatic relief in OA while limiting the adverse effects due to long-term use of analgesics and NSAIDs.

Overview of First-Line and Second-Line Pharmacotherapies for Osteoarthritis with Special Focus on Intra-Articular Treatment

“…Taken in therapeutic doses, paracetamol is remarkably well tolerated and metabolized, and the metabolic products are excreted in the urine [39]. Although paracetamol has minimal effects on symptoms, it is widely recommended as a first-line oral analgesic, presumably due to its availability, low cost, and assumed safety [14].…”

“…This first step is often overlooked or insufficiently emphasized, to the detriment of patients [13]. Pain medications, including the most popular NSAIDs, are the first-line treatment [14]. However local treatment has been used more widely, which in the hierarchy of proceedings takes place between rehabilitation and pharmacological treatment.…”

Clinical efficacy of Yiqi Yangxue formula on knee osteoarthritis and unraveling therapeutic mechanism through plasma metabolites in rats

“…All available forms of KOA therapy are based on symptomatic treatment, such as pain relief and joint function improvement ( Nowaczyk et al, 2022 ). Pain medications, including the most popular non-steroidal anti-inflammatory drugs (NSAIDs), are the first-line treatment ( Gnylorybov et al, 2020 ). Surgery should be considered only in the case of no improvement and the presence of advanced lesions visible in imaging tests.…”

Role of macrophage polarization in osteoarthritis (Review)

“…OA is characterized by synovitis, osteophyte formation and degeneration of joint-related tissues (such as articular cartilage), which may eventually result in changes in bone structure and disability of patients (3). Traditional treatments include physical therapy, anti-inflammatory and analgesic drugs and injecting glucocorticoid or hyaluronic acid into the joint (4)(5)(6). However, at present, most OA therapies have limited efficacy in symptom relief.…”