Comprehensive local injection therapy effectiveness for osteoarthritis
E.A. Beliaeva, O.S. Avdeeva
Tula State University
Aim: to study the comprehensive therapy effectiveness in knee osteoarthritis (OA).
Patients and methods: the study involved 125 patients aged 50 to 70 years. Of them, 25 men and 100 women were diagnosed with Grade 3 knee OA by Kellgren-Lawrence. The average age of patients was 62 ± 3.21 years and the average disease duration — 9.4 ± 2.8 years. Patients were randomized into three groups of 35 people, where 20 people were in the control group. Group 1 received NSAIDs + Inektran®, group 2 — NSAIDs + Fermathron®, group 3 — NSAIDs + Inektran® + Fermathron®. The control group received only NSAIDs. Symptoms were assessed using the WOMAC OA index before therapy, and 8 and 12 weeks after. Pain intensity during walking was measured by VAS.
Results: pain reduction dynamic during walking was comparable and amounted to slightly more than 30 % in both groups, receiving one of the drugs (Inektran® (group 1) or Fermathron® (group 2)). These significant values were compared to the initial values (p<0.01). Pain during walking decreased by more than 50% of baseline values in group 3, to which both drugs (Inektran®+Fermathron®) were prescribed. That is, the co-administration of two drugs simultaneously allowed to improve the therapy results by 1.5 times. Patients’ need for NSAIDs before and after conducted therapy was also investigated. Patients were able to reduce the NSAIDs dosage in all the study groups.
Conclusion: the total WOMAC OA index reduction to the greatest extent was observed in group 3 (Inektran®+Fermathron®) — by more than 50%, in group 1 (Inektran®) and group 2 (Fermathron®) — by more than 40%, in the control group — by 20%, by the end of the therapy. After 12 weeks, there was a tendency to the conducted therapy effect retention and even its increment in all the groups.
Keywords: osteoarthritis, knee joint, chondroitin sulfate, sodium hyaluronate, comprehensive therapy.
For citation: Beliaeva E.A., Avdeeva O.S. et al. Comprehensive local injection therapy effectiveness for osteoarthritis. RMJ. Medical Review. 2019;4(I):23–28.
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26. Лапшина С.А., Мухина Р.Г., Мясоутова Л.И. Остеоартроз: современные проблемы терапии. РМЖ. 2016;2:95–101. [Lapshina S.A., Mukhina R.G., Myasoutova L.I. Osteoarthritis: current problems of therapy. RMJ. 2016;2:95–101 (in Russ.)].
2. Фаломеева О.Н., Галушка Е.А., Эрдес Ш.Ф. Распространенность ревматических заболеваний в России и США. Научно-практическая ревматология. 2008;46(4):4–13. [Falomeeva O.N., Galushka E.A., Erdes Sh.F. Prevalence of rheumatic diseases in Russia and the USA. Scientific and practical rheumatology. 2008;46(4):4–13 (in Russ.)].
3. Шумада И.В. Диагностика и лечение дегенеративно-дистрофических поражений суставов. Киев: Здоровье; 1990. [Shumada I.V. Diagnosis and treatment of degenerative-dystrophic lesions of the joints. Kiev: Health; 1990 (in Russ.)].
4. Xia B., Di Chen, Zhang J. et al. Osteoarthritis pathogenesis: a review of molecular mechanisms. Calcif. Tissue Int. 2014;95(6):495–505.
5. Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis Cartilage. 2013;21:16–21.
6. Дубиков А.И. Остеоартроз: старая болезнь, новые подходы. Совр. ревматология. 2013;2:82–88. [Dubikov A.I. Osteoarthritis: old disease, new approaches. Sovr. rheumatology. 2013;2:82–88 (in Russ.)].
7. Каратеев А.И., Лила А.М. Остеоартрит: современная клиническая концепция и некоторые перспективные терапевтические подходы. Научно-практическая ревматология. 2018;56(1):70–81. [Karateev A.I., Lyla A.M. Osteoarthritis: a modern clinical concept and some promising therapeutic approaches. Scientific and practical rheumatology. 2018;56(1):70–81 (in Russ.)].
8. Robinson W.H., Lepus C.M., Wang Q. et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat rev Rheumatol. 2016;12(10):580–592. DOI: 10.1038/nrrheum.2016.
9. Лила А.М., Громова О.А., Торшин И.Ю. и др. Молекулярные эффекты хондрогарда при остеоартрите и грыжах межпозвоночного диска. Неврология. Нейропсихиатрия, психосоматика. 2017;9(3):88–97. [Lyla A.M., Gromova O.A., Torshin I.Yu. et al. Molecular effects of chondrogard in osteoarthritis and herniated intervertebral disk. Neurology. Neuropsychiatry, psychosomatics. 2017;9(3):88–97 (in Russ.)].
10. Ступенчатая терапия хондроитина сульфатом у больных остеоартритом на поликлиническом этапе. Современная ревматология. 2017;11(3):77–80 [Stepwise therapy of chondroitin sulfate in most osteoarthritis at the outpatient clinic. Modern Rheumatology. 2017;11(3):77–80 (in Russ.)].
11. Каратеев А.Е., Лила А.М. Российский опыт применения инъекционных форм хондроитина сульфата и глюкозамина сульфата: обзор клинических исследований. Современная ревматология. 2018;12(1):33–40. [Karateev A.E., Lyla A.M. Russian experience in the use of injectable forms of chondroitin sulfate and glucosamine sulfate: a review of clinical studies. Contemporary Rheumatology. 2018;12(1):33–40 (in Russ.)].
12. Имаметдинова Г.Р., Чичасова Н.В. Хондроитина сульфат при заболеваниях опорно-двигательного аппарата: эффективность и безопасность с позиций доказательной медицины. РМЖ. 2016;22:1481–1488. [Imametdinova G.R., Chichasova N.V. Hondroitina sulfate in diseases of the musculoskeletal system: effectiveness and safety from the standpoint of evidence-based medicine. RMJ. 2016;22:1481–1488 (in Russ.)].
13. Ronca F., Palmieri L., Panicucci P., Ronca G. Antiinflammatori activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998;May 6(Suppl A):14–21.
14. Bruyere O., Cooper C.C., Pelletier J.P. et al. An algorithm recommendation for the management of knee osteoarthritis in Europe andinternationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;44(3):253–263.
15. Bruyere O., Cooper C.C., Pelletier J.P. et al. A consensus statement on the the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Algorithm for the management of knee osteoarthritis — From evidence-based medicine to the real-life setting. Semin Arthritis Rheum. 2016;45(4):3–11.
16. Епифанов В.А. Остеохондроз позвоночника: диагностика, лечение, профилактика. М.: МЕДпресс-информ; 2004. [Epifanov V.A. Spinal osteochondrosis: diagnosis, treatment, profilatika. M.: MEDPress-Inform; 2004 (in Russ.)].
17. Федорищев И.А. Гиалуроновая кислота. М.; 2011. [Fedorishchev I.A. Hyaluronic Acid. M.; 2011 (in Russ.)].
18. Henrotin Y., Raman R., Richette P. et al. Consensus statement jn viscosupplementation with hyaluronic acid for the management of OA. Semin Arthritis Rheum. 2015;45(2):140–149.
19. Yasui T., Acatsuca M., Tobetto K. et al. The effect of hyaluronan on interleukin-1 alpha- induced prostaglandin E2 production in human OA sinovial cells. Agents Actions. 1992;37(1–2):155–156.
20. Campo G.M., Avenoso A., Campo S. et al. Chondroitin-4-sulfate ingibits NF-kB translocation and caspase fctivation in collagen-induced arthritis in mice. Osteoarthritis Cartilage. 2008;16(12):1474–1483.
21. Volpi N. Anti-inflammatory activity of chondroitin sulfate: new functions from an old natural macromolecule. Inflammopharmacology. 2011;19(6):299–306.
22. Imada K., Oka H., Kawasaki D. et al. Antiarthritic action mechanisms of natural chondroitin sulfate in human articular chondrocytes and synovial fibroblasts. Biol Pharm Bull. 2010;33(3):410–414.
23. Вакуленко О.Ю., Жиляев Е.В. Остеоартроз: современные подходы к лечению. РМЖ. 2016;22:1494–1498. [Vakulenko O.Yu., Zhilyaev E.V. Osteoarthritis: modern approaches to treatment. RMJ. 2016;22:1494–1498 (in Russ.)].
24. Пилипович А.А. Остеоартроз: патогенетические и терапевтические аспекты. РМЖ. 2016;7:464–468. [Pilipovich A.A. Osteoarthritis: pathogenetic and therapeutic aspects. RMJ. 2016;7:464–468 (in Russ.)].
25. Олюнин Ю.А. Остеоартроз. Актуальные вопросы диагностики и лечения. РМЖ. 2012;7:385. [Olyunin Yu.A. Osteoarthritis. Current issues of diagnosis and treatment. RMJ. 2012;7:385 (in Russ.)].
26. Лапшина С.А., Мухина Р.Г., Мясоутова Л.И. Остеоартроз: современные проблемы терапии. РМЖ. 2016;2:95–101. [Lapshina S.A., Mukhina R.G., Myasoutova L.I. Osteoarthritis: current problems of therapy. RMJ. 2016;2:95–101 (in Russ.)].
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