Effectiveness of pathogenetic correction of sarcopenia in patients with osteoarthritis

Effectiveness of pathogenetic correction of sarcopenia in patients with osteoarthritis

¹Bashkir State Medical University, Ufa

²Medical Center "Novomeditsina" LLC, Rostov-on-Don

³Federal Research Center "Informatics and Management" of the Russian Academy of Science, Moscow

⁴N.N. Priorov National Medical Research Center for Traumatology and Orthopedics, Moscow

⁵RUDN University, Moscow

Background: there is an unmet need to optimize pharmacological and adjunctive treatment tactics for the management of sarcopenia in elderly patients with osteoarthritis (OA) undergoing total joint replacement (TJR).

Aim: to evaluate the efficacy and safety of a stepwise sarcopenia treatment regimen comprising parenteral chondroitin sulfate (CS) and subsequent pharmaconutraceutical support in elderly patients with stage III knee osteoarthritis according to the Kellgren–Lawrence classification and grade 2 joint functional insufficiency (FI) undergoing TJR.

Materials and Methods: an open-label, prospective, randomized, controlled study was conducted in accordance with predefined inclusion and exclusion criteria. The total follow-up period was 126 days, with assessments at Visit 0, Visit 1, and Visit 2. TJR was performed using the C. Ranawat technique. The study enrolled 62 patients with knee OA and sarcopenia, allocated to the main group (MG, n=32) and control group (CG, n=30). All patients received systemic and topical nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, patients in the MG received intramuscular CS (Chondroguard) administered every other day for 50 days prior to TJR, followed by pharmaconutraceutical (composition per daily dose: glucosamine sulfate [GS] 1500 mg, CS 1200 mg, undenatured type II collagen 40 mg; Chondroguard TRIO) for 2 months after hospital discharge. Pain intensity was assessed using the visual analogue scale (VAS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lequesne index for joint function. The severity of sarcopenia was evaluated using the SARC-F questionnaire, handgrip dynamometry, the 5-chair stand test, and the skeletal muscle index (DXA). Histological examination of quadriceps femoris muscle biopsies was performed. Serum levels of albumin, leptin, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-α (TNF-α), IL-1β, N-terminal propeptide of type IIA procollagen (PIIANP), brain-derived neurotrophic factor (BDNF), myostatin, follistatin, insulin-like growth factor 1 (IGF-1), dehydroepiandrosterone sulfate (DHEAS), cortisol, 25-hydroxyvitamin D3 [25(OH)D3], vitamin C, total carotenoids, and α-tocopherol were measured, and the sarcopenia index was calculated.

Results: at Visits 1 and 2, patients in the MG demonstrated a significant reduction in pain intensity according to VAS, WOMAC, and KOOS scores, as well as an improvement in joint function according to the Lequesne index, compared both with baseline (Visit 0) and with the CG. A decrease in sarcopenia severity was observed in the MG, as evidenced by improved SARC-F scores, shorter times in the 5-chair stand test, and an increase in skeletal muscle index (DXA), relative to Visit 0 and to the CG. There was an improvement in the serum vitamin profile, a reduction in markers of systemic inflammation, and increases in serum albumin, BDNF, IGF-1, and DHEAS, along with an increase in the sarcopenia index. Concurrently, reductions in serum PIIANP, myostatin, follistatin, and cortisol were recorded in the MG compared with baseline and with the CG at Visit 1. At Visit 2, significant between-group differences in handgrip dynamometry were observed in favor of the MG. Histological assessment of quadriceps muscle biopsies in the MG revealed signs of adaptive myofibrillar hypertrophy, an increased number of myocyte nuclei, and initial manifestations of connective tissue proliferation. The requirement for celecoxib decreased progressively in the MG, with complete discontinuation in 18.7% and 81.3% of patients by day 60 of the study, respectively; topical meloxicam was discontinued in 31.2% and 68.8% of MG patients by day 60.

Conclusion: in elderly patients with knee OA and pain undergoing TJR, a stepwise therapeutic approach combining parenteral CS with subsequent pharmaconutraceutical support appears to be a promising strategy for the management of sarcopenia.

Keywords: sarcopenia, elderly patients, osteoarthritis, efficacy, safety, chondroitin sulfate, glucosamine sulfate, undenatured type II collagen, Chondroguard, Chondroguard TRIO.

For citation: Minasov T.B., Sarvilina I.V., Gromova O.A., Nazarenko A.G., Zagorodniy N.V., Yakupova E.R. Effectiveness of pathogenetic correction of sarcopenia in patients with osteoarthritis. RMJ. 2025;10:9–20. DOI: 10.32364/2225-2282-2025-10-2