Chondroitin sulfate: treatment tactics in osteoarthritis
DOI: 10.32364/2587-6821-2021-5-2-102-106
Rostov State Medical University, Rostov-on-Don, Russian Federation
Osteoarthritis (OA) is the most common among all musculoskeletal disorders, becoming the main cause of chronic pain, impaired static and dynamic function and disability among the elderly, and represents the main burden for public health worldwide. Modern pharmacological treatment methods of OA are focused on reducing the disease symptoms and the pain syndrome intensity. One method in this direction is the use of symptom-modifying slow-acting drugs, which have shown promising positive effects on pain and other OA symptoms. The article presents an overview of the main experimental and clinical studies, and meta-analyses devoted to the evaluation of chondroitin sulfate (CS) efficacy and safety as one of the most commonly prescribed drugs for the treatment of OA. Some studies are devoted to the assessment of structural changes in articular cartilage during CS and placebo therapy, while others focus on the dynamics of pain syndrome and the degree of functional insufficiency, and on the assessment of the incidence and time of delayed knee replacement. The place of CS in the structure of EULAR and ESCEO recommendations is considered.
Keywords: osteoarthritis, chondroitin sulfate, symptom-modifying slow-acting drugs, medial condyle, articular cartilage thickness, articular replacement.
For citation: Alabut A.V. Chondroitin sulfate: treatment tactics in osteoarthritis. Russian Medical Inquiry. 2021;5(2):102–106. DOI: 10.32364/2587-6821-2021-5-2-102-106.
Acknowledgment
Editorial Board is grateful to Pierre Fabre for the assistance in technical edition of this publication.
Сведения об авторе:
Алабут Анна Владимировна — д.м.н., доцент, профессор кафедры травматологии и ортопедии, заведующая травматолого-ортопедическим отделением № 1 клиники ФГБОУ ВО РостГМУ Минздрава России; 344022, Россия, г. Ростов-на-Дону, Нахичеванский пр-т, д. 29; ORCID iD 0000-0002-5247-2646.
Контактная информация: Алабут Анна Владимировна, e-mail: alabut@mail.ru. Прозрачность финансовой деятельности: автор не имеет финансовой заинтересованности в представленных материалах или методах. Конфликт интересов отсутствует. Статья поступила 25.01.2021, поступила после рецензирования 17.02.2021, принята в печать 17.03.2021.
About the author:
Anna V. Alabut — Dr. of Sci. (Med.), Associate Professor, Professor of the Department of Traumatology and Orthopedics, Head of the Department of Traumatology and Orthopedics No. 1, Rostov State Medical University; 29, Nakhichevanskiy lane, Rostov-on-Don, 344022, Russian Federation; ORCID iD 0000-0002-5247-2646.
Contact information: Anna V. Alabut, e-mail: alabut@mail.ru. Financial Disclosure: the author has no a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 25.01.2021, revised 17.02.2021, accepted 17.03.2021.
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5. Kurtz S.M., Lau E., Ong K.L. Universal health insurance coverage in Massachusetts did not change the trajectory of arthroplasty use or costs. Clin Orthop Relat Res. 2016;474(5):1090–1098. DOI: 10.1007/s11999-015-4643-9.
6. Pabinger C., Geissler A. Utilization rates of hip arthroplasty in OECD countries. Osteoarthritis Cartilage. 2014;22(6):734–741. DOI: 10.1016/j.joca.2014.04.009.
7. Pabinger C., Lothaller H., Geissler A. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis Cartilage. 2015;23(10):1664–1673. DOI: 10.1016/j.joca.2015.05.008.
8. Nemes S., Rolfson O., W.-Dahl A. et al. Historical view and future demand for knee arthroplasty in Sweden. Acta Orthop. 2015;86(4):426–431. DOI: 10.3109/17453674.2015.1034608.
9. Number of knee replacements in sel ect countries 2019, Published by Conor Stewart, Oct 16, 2020 (Electronic resource.) URL: https://www.statista.com/statistics/236586/number-of-knee-operations-in-selected-countries/ (access date: 01.22.2021).
10. Hiligsmann M., Cooper C., Arden N. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2013;43(3):303–313. DOI: 10.1016/j.semarthrit.2013.07.003.
11. Puig-Junoy J., Ruiz Zamora A. Socio-economic costs of osteoarthritis: a systematic review of cost-of-illness studies. Semin Arthritis Rheum. 2015;44(5):531–541. DOI: 10.1016/j.semarthrit.2014.10.012.
12. Chu L., Liu X., He Z. et al. Articular Cartilage Degradation and Aberrant Subchondral Bone Remodeling in Patients with Osteoarthritis and Osteoporosis. J Bone Miner Res. 2020;35:505–515. DOI: 10.1002/jbmr.3909.
13. Robinson W.H., Lepus C.M., Wang Q. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580–592. DOI: 10.1038/nrrheum.2016.136.
14. Uebelhart D. Clinical review of chondroitin sulfate in osteoarthritis. Osteoarthritis Cartilage. 2008;16(Suppl 3):S19–21. DOI: 10.1016/j.joca.2008.06.006.
15. Kloppenburg M., Kroon F.P., Blanco F.J. et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019;78(1):16–24. DOI: 10.1136/annrheumdis-2018-213826.
16. Jordan K.M., Arden N.K., Doherty M. et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–1155. DOI: 10.1136/ard.2003.011742.
17. Zhang W., Doherty M., Arden N. et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64:669–681. DOI: 10.1136/ard.2004.028886.
18. Bruyère O., Honvo G., Veronese N. 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.
19. Bruyère O., Cooper C., Al-Daghri N.M. et al. Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res. 2018;30(2):111–117. DOI: 10.1007/s40520-017-0861-1.
20. Martel-Pelletier J., Kwan Tat S., Pelletier J.P. Effects of chondroitin sulfate in the pathophysiology of the osteoarthritic joint: a narrative review. Osteoarthritis Cartilage. 2010;18(Suppl 1):S7–11. DOI: 10.1016/j.joca.2010.01.015.
21. Volpi N. Analytical aspects of pharmaceutical grade chondroitin sulfates. J Pharm Sci. 2007;96(12):3168–3180. DOI: 10.1002/jps.20997.
22. Hochberg M., Chevalier X., Henrotin Y. Symptom and structure modification in osteoarthritis with pharmaceutical-grade chondroitin sulfate: what’s the evidence? Curr Med Res Opin. 2013;29(3):259–267. DOI: 10.1185/03007995.2012.753430.
23. Du Souich P., Garcia A.G., Verges J. Immunomodulatory and anti-inflammatory effects of chondroitin sulphate. J Cell Mol Med. 2009;13(8A):1451–1463. DOI: 10.1111/j.1582-4934.2009.00826.x.
24. Volpi N. Anti-inflammatory activity of chondroitin sulphate: new functions from an old natural macromolecule. Inflammopharmacology. 2011;19(6):299–306. DOI: 10.1007/s10787-011-0098-0.
25. Monfort J., Pelletier J.P., Garcia-Giralt N. Biochemical basis of the effect of chondroitin sulphate on osteoarthritis articular tissues. Ann Rheum Dis. 2008;67(6):735–740. DOI: 10.1136/ard.2006.06888.
26. Bassleer C.T., Combal J.P., Bougaret S. Effects of chondroitin sulfate and interleukin-1 beta on human articular chondrocytes cultivated in clusters. Osteoarthritis Cartilage. 1998;6(3):196–204. DOI: 10.1053/joca.1998.0112.
27. Uebelhart D., Thonar E.J., Zhang J. Protective effect of exogenous chondroitin 4,6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthritis Cartilage. 1998;6(Suppl A):6–13. DOI: 10.1016/S1063-4584(98)80005-8.
28. Pecchi E., Priam S., Mladenovic Z. A potential role of chondroitin sulfate on bone in osteoarthritis: inhibition of prostaglandin E and matrix metalloproteinases synthesis in interleukin-1beta-stimulated osteoblasts. Osteoarthritis Cartilage. 2012;20(2):127–135. DOI: 10.1016/j.joca.2011.12.002.
29. Cho S.Y., Sim, J.S., Jeong C.S. Effects of low molecular weight chondroitin sulfate on type II collagen-induced arthritis in DBA/1J mice. Biol Pharm Bull. 2004;27(1):47–51. DOI: 10.1248/bpb.27.47.
30. Omata T., Itokazu Y., Inoue N. Effects of chondroitin sulfate-C on articular cartilage destruction in murine collagen-induced arthritis. Arzneimittelforschung. 2000;50(2):148–153. DOI: 10.1055/s-0031-1300180.
31. Manno R.L., Bingham C.O. 3rd, Paternotte S. et al. OARSI-OMERACT initiative: defining thresholds for symptomatic severity and structural changes in disease modifying osteoarthritis drug (DMOAD) clinical trials. Osteoarthritis Cartilage. 2012;20(2):93–101. DOI: 10.1016/j.joca.2011.11.013.
32. Wildi L.M., Raynauld J., Martel-Pelletier J. et al. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011;70:982–989. DOI: 10.1136/ard.2010.140848.
33. Raynauld J.P., Martel-Pelletier J., Berthiaume M.J. et al. Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes. Arthritis Rheum. 2004;50:476–487. DOI: 10.1002/art.20000.
34. Kauffmann C., Gravel P., Godbout B. et al. Computer-aided method for quantification of cartilage thickness and volume changes using MRI: validation study using a synthetic model. IEEE Trans Biomed Eng. 2003;50:978–988. DOI: 10.1109/TBME.2003.814539.
35. Railhac J.J., Zaim M., Saurel A.S. et al. Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI. Clin Rheumatol. 2012;31(9):1347–1357. DOI: 10.1007/s10067-012-2022-4.
36. Pelletier J.-P., Raynauld J.P., Beaulieu A.D. et al. Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study. Arthritis Res Ther. 2016;18(1):256. DOI: 10.1186/s13075-016-1149-0.
37. Mazieres B., Combe B., Phan van A. et al. Chondroitin sulfate in osteoarthritis of the knee: a prospective, double blind, placebo controlled multicenter clinical study. J Rheumatol. 2001;28(1):173–181. PMID: 11196521.
38. Mazières B., Hucher M., Zaïm M., Garnero P. Effect of chondroitin sulphate in symptomatic knee osteoarthritis: a multicentre, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2007;66(5):639–645. DOI: 10.1136/ard.2006.059899.
39. Reginster J.Y., Dudler J., Blicharski T., Pavelka K. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017;76(9):1537–1543. DOI: 10.1136/annrheumdis-2016-210860.
40. Schneider H., Maheu E., Cucherat M. Symptom-modifying effect of chondroitin sulfate in knee osteoarthritis: a meta-analysis of randomized placebo-controlled trials performed with Structum®. Open Rheumatol J. 2012;6:183–189. DOI: 10.2174/1874312901206010183.
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