Modern Chondroprotectors in the Therapy of Osteoarthritis

Abstract

Introduction. Osteoarthritis is a chronic progressive degenerative disease of the entire joint that affects the articular cartilage, subchondral bone, ligaments, capsule and synovial membrane. Osteoarthritis was previously considered as a mechanical wear-and-tear disease causing degeneration of cartilage, but at present it is clear that the relationship between various joint structures and local inflammation is a central aspect of the underlying pathophysiology. Over the past 20 years, significant progress has been made in osteoarthritis research; however, many questions remain unanswered due to the complexity of the pathophysiology of osteoarthritis. Osteoarthritis is a condition characterized by a high level of comorbidity, primarily due to advanced age being the most influential factor among all the risk factors associated with its development. Additionally, research indicates that individuals with osteoarthritis face a significantly elevated risk of developing comorbid conditions compared to those without this disease.
 Objectives. This study aims at summarizing the most promising therapeutic approaches using chondroprotectors (chondroitin sulfate, Alflutop) in the treatment of patients with osteoarthritis and comorbid pathologies based on the latest pharmacological achievements in the therapy of osteoarthritis.
 Materials and methods. The study was conducted at the Rheumatology Center of M.V. Sklifosovsky Poltava Regional Hospital. 150 patients with osteoarthritis in the period of exacerbation aged 41-73 were examined and received therapy. Among them there were 97 (64.67%) women and 53 (35.33%) men having comorbid diseases (arterial hypertension, coronary heart disease, diseases of the digestive, respiratory, endocrine, genitourinary systems). Radiologically, all patients showed II-III stages of joint lesions according to the Kellgren-Lawrence classification. The history of osteoarthritis lasted 5-19 years. Verification of the clinical diagnosis of osteoarthritis was carried out according to the recommendations of EULAR (2018) based on the findings of clinical, laboratory and instrumental studies. Clinical diagnoses of comorbid conditions were established in accordance with the relevant orders of the Ministry of Health of Ukraine and confirmed by specialists. The patients received standard therapy: non-steroidal anti-inflammatory drugs, chondroprotectors (chondroitin sulfate or Alflutop), gastroprotectors, local treatment according to the order of the Ministry of Health of Ukraine No. 676 dated 12.10.2006, Specialty "Rheumatology". If necessary, additional medications for the treatment of comorbid pathologies (hypotensive, anti-ischemic, anti-diabetic, hypolipidemic) were prescribed according to the recommendations of specialists.
 Prior to beginning the treatment course and following the examination of patients to establish a clinical diagnosis of osteoarthritis, we conducted a thorough assessment to rule out thrombophlebitis. This involved a coagulogram, an ultrasound examination of the lower extremity vessels, and consultation with a vascular surgeon when necessary. In cases where thrombophlebitis of the lower extremities was clinically diagnosed, patients were prescribed Alflutop in a dose of 1.0 ml intramuscularly once a day for 20 days as a chondroprotective agent. For patients without signs of lower extremity thrombophlebitis, chondroitin sulfate was administered in a dose of 2.0 ml intramuscularly once a day for 20 days. The administration of these chondroprotective agents followed a schedule of once every 6 months for the patients.
 Results. The literature regarding the complete understanding of the treatment of patients with osteoarthritis with comorbid pathology enabled us to elaborate a targeted effective therapy taking into account the appointment of the appropriate chondroprotector based on the anamnesis of the disease and the comorbid condition. This therapeutic approach contributed to prolonging the remission of the underlying disease and comorbid pathology, reducing the frequency of hospitalization and shortening the inpatient treatment by 2-3 days.
 Conclusions. The proposed approach in the treatment of patients with osteoarthritis and comorbid pathology, features of the appointment of chondroprotectors with a high prognostic value in prolonging the remission of osteoarthritis and related diseases will improve their practical application.