Chondroitin sulfate injection efficacy in the treatment of knee osteoarthritis
DOI: 10.32364/2587-6821-2021-5-5-301-306
S.A. Lapshina, G.F. Mingaleeva
Kazan State Medical University, Kazan, Russian Federation
Aim: to evaluate the efficacy of two-month therapy with chondroitin sulfate (CS) (Mucosat®) injections in patients with osteoarthritis and the drug potential in terms of structure-modifying action.
Patients and Methods: an open prospective study with participation of 30 patients (mean age 52.5±11.7 years) with osteoarthritis, grade 2 gonarthrosis according to the Kellgren-Lawrence classification, and severe pain syndrome (more than 50 points according to VAS) was conducted. 76.7% of subjects had concomitant pathology. The drug was prescribed according to the standard regimen with a course of up to 25–30 injections. The examination included a clinical assessment of indicators of joint syndrome, life quality, joint function using WOMAC, Lekken, KOOS, EQ-5D scales, cartilage oligomeric matrix protein (COMP) and C-reactive protein (CRP), ultrasound of the knee joints.
Results: after a two-month treatment course with Mucosat®, there was a significant (p<0.05) decrease in pain intensity by 1.8 times, the number of tender and swollen joints by 2 or more times, an improvement in indicators of functional activity and life quality of patients. Reactive synovitis of the knee joints, which was present at the beginning of the study in 53.3% of cases, was preserved clinically and according to ultrasound data only in 17% of subjects by the end of treatment. There was a tendency to decrease the levels of CRP and COMP. Ultrasound of the knee joints showed a significant (p=0.000) increase in the average thickness of articular cartilage from 1.55±0.26 mm initially to 1.67±0.27 mm after 2 months of treatment. More significant positive dynamics during therapy was observed in patients without arterial hypertension. In general, no adverse events were registered during treatment.
Conclusion: in clinical practice, the use of the CS injections in patients with gonarthrosis is safe and effective. The tendency to decrease the cartilage degradation and increase its thickness suggests a positive effect of CS in the form of slowing the disease progression in the long-term period.
Keywords: osteoarthritis, cartilage degradation, synovitis, chondroitin sulfate, bioavailability, structure-modifying effect, Mucosat.
For citation: Lapshina S.A., Mingaleeva G.F. Chondroitin sulfate injection efficacy in the treatment of knee osteoarthritis. Russian Medical Inquiry. 2021;5(5):301–306 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-301-306.
About the authors:
Svetlana A. Lapshina — C. Sc. (Med.), Associate Professor of the Department of Hospital Therapy of the Kazan State Medical University; 49, Butlerov str., Kazan, 420012, Russian Federation; ORCID iD 0000-0001-5474-8565.
Gulnaz F. Mingaleeva — Assistant of the Department of Internal Diseases of the Kazan State Medical University; 49, Butlerov str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-3760-062X.
Contact information: Svetlana A. Lapshina, e-mail: svetlanalapshina@mail.ru.
Financial Disclosure: the study was conducted with the support of DIAMED-Pharma LLC. No authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 11.06.2021.
Received 07.07.2021.
Accepted 30.07.2021.
2. Loeser R.F., Goldring S.R., Scanzello C.R., Goldring M.B. Osteoarthritis, a disease of the joint as an organ. Arthr Rheum. 2012;64(6):1697–707.
3. Balabanova R.M. Osteoarthrosis or osteoarthritis? A current view of the disease and its treatment. Modern Rheumatology Journal. 2013;7(3):67–70 (in Russ.). DOI: 10.14412/1996-7012-2013-276.
4. Sellam J., Berenbaum F. The role of synovitis in pathophysiology and clinical symtoms of osteoarthritis. Nat Rev Rheumatol. 2010;6(11):625–635. DOI: 0.1038/nrrheum.2010.159.
5. Zhuo Q., Yang W., Chen J. et al. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012;8:729–737. DOI: 10.1038/nrrheum.2012.135.
6. Xueqing Yang, Guangfeng Ruan, Jianhua Xu et al. Associations between suprapatellar pouch effusion-synovitis, serum cartilage oligomeric matrix protein, high sensitivity C-reaction protein, knee symptom, and joint structural changes in patients with knee osteoarthritis. Clin Rheumatol. 2020;39(5):1663–1670. DOI: 10.1007/s10067-019-04905-7.
7. Rajath Siddaramanna Onkarappa, Devendra Kumar Chauhan, Biman Saikia et al. Metabolic syndrome and its effects on cartilage degeneration vs regeneration: a pilot study using osteoarthritis biomarkers. Ind J Orthop. 2020;54(Suppl 1):20–24. DOI: 10.1007/s43465-020-00145-z.
8. Akinmade A., Oginni L.M., Olayinka O. Adegbehingbe et al. Serum cartilage oligomeric matrix protein as a biomarker for predicting development and progression of knee osteoarthritis. Int Orthop. 2021;45(3):551–557. DOI: 10.1007/s00264-021-04943-4.
9. Naumov A.V., Alekseeva L.I., Vertkin A.L. et al. Management of patients with osteoarthritis and comobidity in general medical practice. Clinical recommendations of the consensus of experts of the Russian Federation. M.; 2015 (in Russ.).
10. Puenpatom R.A., Timothy W., Victor T.W. Increased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III Data. Postgrad Med. 2009;121:9–20. DOI: 10.3810/pgm.2009.11.2073.
11. Sellam J., Berenbaum F. Is osteoarthritis a metabolic disease? J Bone Spine. 2013;80(6):568–573. DOI: 10.1016/j.jbspin.2013.09.007.
12. Le Clanche S., Bonnefont-Rousselot D., Sari-Ali E. et al. Inter-relations between osteoarthritis and metabolic syndrome: A common link? Biochimie. 2016;121:238–252. DOI: 10.1016/j.biochi.2015.12.008.
13. Findlay D.M. Vascular pathology and osteoarthritis. Rheumatology (Oxford). 2007;46(12):1763–1768. DOI: 10.1093/rheumatology/kem191.
14. Huizhen Lv, Hui Wang, Meixi Quan, Chenghu Zhang et al. Cartilage oligomeric matrix protein fine-tunes disturbed flow-induced endothelial activation and atherogenesis. Matrix Biol. 2021;95:32–51. DOI: 10.1016/j.matbio.2020.10.003.
15. Arden N.K., Perry T.A., Bannuru R.R. et al. Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nat Rev Rheumatol. 2021;17(1):59–66. DOI: 10.1038/s41584-020-00523-9.
16. Alekseeva L.I. Сlinical guidelines update on the treatment of patients with osteoarthritis in 2019. RMJ. 2019;4:2–6 (in Russ.)].
17. Honvo G., Veronese N., Branco J. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337–350. DOI: 10.1016/j.semarthrit.2019.04.008.
18. Chichasova N.V., Imametdinоva G.R. Treatment in patients with osteoarthritis at different sites: Place of slow-acting drugs. Modern Rheumatology Journal. 2015;9(2):66–74 (in Russ.). DOI: 10.14412/1996-7012-2015-2-66-74.
19. Reginster J., Veronese Т. Highly purified chondroitin sulfate: a literature review on clinical efficacy and pharmacoeconomic aspects in osteoarthritis treatment. Aging Clin Exp Res. 2021;33:37–47. DOI: 10.1007/s40520-020-01643-8.
20. Makarova M.V., Valkov M.Yu. Comparison of the diagnostic accuracy of magnetic resonance imaging and ultrasound examination for X-ray negative stage of knee joints osteoarthritis. Research and Practical Medicine Journal. 2018;5(1):10–19 (in Russ.). DOI: 10.17709/2409-2231-2018-5-1-1.

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