Chondroprotective therapy of osteoarthritis: a tribute to tradition or a proven necessity?
DOI: 10.32364/2587-6821-2022-6-8-480-485
I.V. Egorov
Institute of Integrative Family Therapy, Moscow, Russian Federation
The study of cellular and molecular patterns of osteoarthritis (OA) shows that, since the key sign of the disease is progressive cartilage loss, today it is considered as a spectrum of conditions affecting all joint tissues. The disease is based on special tissue mechanisms: some of them are unique to a single tissue, and some are common to several tissues and joints. Recent studies allowed to identify individual subtypes of OA, depending on the development of pathological changes in certain tissue: bone tissue, articular cartilage, inflammation or changes in the synovial membrane. Therefore, chondroprotection requires a holistic approach, stratification of patient groups and achievement of their respective final goals. Given the past therapeutic experience (including unsuccessful), it is necessary to develop medicinal products using modern technologies and the latest knowledge. The main aim of chondroprotection is to provide the suitable treatment to the appropriate patient at the right time. Despite the abundance of new technologies and pharmacological developments, European experts still recommend a combination of chondroitin sulfate and glucosamine as the treatment of choice at the initial stage of OA.
Keywords: chondroprotection, osteoarthritis, treatment tactics, development of medicinal products, chondroitin sulfate, glucosamine.
For citation: Egorov I.V. Chondroprotective therapy of osteoarthritis: a tribute to tradition or a proven necessity? Russian Medical Inquiry. 2022;6(8):480–485 (in Russ.). DOI: 10.32364/2587-6821-2022-6-8-480-485.
About the author:
Ilya V. Egorov — Dr. Sc. (Med.), Professor, Head of the Department of Family Practice, Institute of Integrative Family Therapy; 60, bldg. 1, aprtm. 9, Vavilova str., Moscow, 119296, Russian Federation; ORCID iD 0000-0001-5896-429X.
Contact information: Ilya V. Egorov, e-mail: ilegor@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 14.07.2022.
Revised 08.08.2022.
Accepted 31.08.2022.
References
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14. Hochberg M., Chevalier X., Henrotin Y. et al. 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.
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25. Fatimah N., Salim B., Raja E.U., Nasim A. Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint. Clin Rheumatol. 2016;35(10):2541–2547. DOI: 10.1007/s10067-016-3365-z.
26. Collins J.E., Deshpande B.R., Katz J.N., Losina E. Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2016;68(7):965–973. DOI: 10.1002/acr.22771.
27. Logerstedt D.S., Zeni J.Jr., Snyder-Mackler L. Sex differences in patients with different stages of knee osteoarthritis. Arch Phys Med Rehabil. 2014;95(12):2376–2381. DOI: 10.1016/j.apmr.2014.07.414.
28. Roman-Blas J.A., Castañeda S., Largo R., Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis Res Ther. 2009;11(5):241. DOI: 10.1186/ar2791.
29. Jung J.H., Bang C.H., Song G.G. et al. Knee osteoarthritis and menopausal hormone therapy in postmenopausal women: a nationwide cross-sectional study. Menopause. 2018;26(6):598–602. DOI: 10.1097/GME.
30. Sun M.M., Beier F., Ratneswaran A. Nuclear receptors as potential drug targets in osteoarthritis. Curr Opin Pharmacol. 2018;40:81–86. DOI: 10.1016/j.coph.2018.03.008.
31. Schott E.M., Farnsworth C.W., Grier A. et al. Targeting the gut microbiome to treat the osteoarthritis of obesity. JCI Insight. 2018;3(8):e95997. DOI: 10.1172/jci.insight.95997.
32. Hart H.F., Gross K.D., Crossley K.M. et al. Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The multicenter osteoarthritis study. Arthritis Care Res (Hoboken). 2020;72(1):107–113. DOI: 10.1002/acr.23864.
33. Ackerman I.N, Bohensky M.A., Kemp J.L., de Steiger R. Likelihood of knee replacement surgery up to 15 years after sports injury: a population-level data linkage study. J Sci Med Sport. 2018;22(6):629–634. DOI: 10.1016/j.jsams.2018.12.010.
34. Gelber A.C., Hochberg M.C., Mead L.A. et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133(5):321–328. DOI: 10.7326/0003-4819-133-5-200009050-00007.
35. McAlindon T.E., LaValley M.P., Harvey W.F. et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. DOI: 10.1001/jama.2017.5283.
36. Lapane K.L., Yang S., Driban J.B. et al. Effects of prescription nonsteroidal antiinflammatory drugs on symptoms and disease progression among patients with knee osteoarthritis. Arthritis Rheumatol. 2015;67(3):724–732. DOI: 10.1002/art.38933.
37. Karsdal M.A., Michaelis M., Ladel C. et al. Disease-modifying treatments for osteoarthritis (DMOADs) of the knee and hip: lessons learned from failures and opportunities for the future. Osteoarthritis Cartilage. 2016;24(12):2013–2021. DOI: 10.1016/j.joca.2016.07.017.
38. Loeser R.F., Goldring S.R., Scanzello C.R., Goldring M.B. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697–1707. DOI: 10.1002/art.34453.
39. Styrkarsdottir U., Lund S.H., Thorleifsson G. et al. Meta-analysis of Icelandic and UK data sets identifies missense variants in SMO, IL11, COL11A1 and 13 more new loci associated with osteoarthritis. Nat Genet. 2018;50(12):1681–1687. DOI: 10.1038/s41588-018-0247-0.
40. Zengini E., Hatzikotoulas K., Tachmazidou I. et al. Genome-wide analyses using UK Biobank data provide insights into the genetic architecture of osteoarthritis. Nat Genet. 2018;50(4):549–558. DOI: 10.1038/s41588-018-0079-y.
41. Wandel S., Jüni P., Tendal B. et al. Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675. DOI: 10.1136/bmj.c4675.
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44. Das A.Jr., Hammad T.A. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343–350. DOI: 10.1053/joca.1999.0308.
45. Clegg D.O., Reda D.J., Harris C.L. et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795–808. DOI: 10.1056/NEJMoa052771.
46. Stellavato A., Restaino O.F., Vassallo V. et al. Comparative Analyses of Pharmaceuticals or Food Supplements Containing Chondroitin Sulfate: Are Their Bioactivities Equivalent? Adv Ther. 2019;36(11):3221–3237. DOI: 10.1007/s12325-019-01064-8.
47. Lubis A.M.T., Siagian C., Wonggokusuma E. Comparison of Glucosamine-Chondroitin Sulfate with and without Methylsulfonylmethane in Grade I-II Knee Osteoarthritis: A Double Blind Randomized Controlled Trial. Acta Med Indones. 2017;49(2):105–111. PMID: 28790224.
2. Benedek T.G. A history of the understanding of cartilage. Osteoarthritis Cartilage. 2006;14(3):203–209. DOI: 10.1016/j.joca.2005.08.014.
3. Bekkers J.E., Creemers L.B., Dhert W.J., Saris D.B. Diagnostic Modalities for Diseased Articular Cartilage-From Defect to Degeneration: A Review. Cartilage. 2010;1(3):157–164. DOI: 10.1177/1947603510364539.
4. Biener A.I., Decker S.L., Rohde F. Source of Increased Health Care Spending in the United States. JAMA. 2019;321(12):1147. DOI: 10.1001/jama.2019.0679.
5. Mathiessen A., Slatkowsky-Christensen B., Kvien T.K. et al. Ultrasound-detected osteophytes predict the development of radiographic and clinical features of hand osteoarthritis in the same finger joints 5 years later. RMD Open. 2017;3(2):e000505. DOI: 10.1136/rmdopen-2017-000505.
6. Loeser R.F., Goldring S.R., Scanzello C.R., Goldring M.B. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697–1707. DOI: 10.1002/art.34453.
7. Ridker P.M., Everett B.M., Thuren T. et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119–1131. DOI: 10.1056/NEJMoa1707914.
8. Chevalier X., Eymard F. Anti-IL-1 for the treatment of OA: dead or alive? Nat Rev Rheumatol. 2019;15(4):191–192. DOI: 10.1038/s41584-019-0185-y.
9. Zhang X.X., He S.H., Liang X. et al. Aging, Cell Senescence, the Pathogenesis and Targeted Therapies of Osteoarthritis. Front Pharmacol. 2021;12:728100. DOI: 10.3389/fphar.2021.728100.
10. Geusens P.P., van den Bergh J.P. Osteoporosis and osteoarthritis: shared mechanisms and epidemiology. Curr Opin Rheumatol. 2016;28(2):97–103. DOI: 10.1097/BOR.0000000000000256.
11. Karsdal M.A., Byrjalsen I., Alexandersen P. et al. Treatment of symptomatic knee osteoarthritis with oral salmon calcitonin: results from two phase 3 trials. Osteoarthritis Cartilage. 2015;23(4):532–543. DOI: 10.1016/j.joca.2014.12.019.
12. Jin Y., Smith C., Monteith D. et al. CGRP blockade by galcanezumab was not associated with reductions in signs and symptoms of knee osteoarthritis in a randomized clinical trial. Osteoarthritis Cartilage. 2018;26(12):1609–1618. DOI: 10.1016/j.joca.2018.08.019.
13. Agiba A.M. Nutraceutical formulations containing glucosamine and chondroitin sulphate in the treatment of osteoarthritis: emphasis on clinical efficacy and formulation challenges. Int J Curr Pharm Res. 2017;9(2):1–7. DOI: 10.22159/ijcpr.2017v9i2.17380.
14. Hochberg M., Chevalier X., Henrotin Y. et al. 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.
15. 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.
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(12):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(5):669–681. DOI: 10.1136/ard.2004.028886.
18. Martel-Pelletier J., Roubille C., Abram F. et al. First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. Ann Rheum Dis. 2015;74(3):547–556. DOI: 10.1136/annrheumdis-2013-203906.
19. Davies P.S., Graham S.M., MacFarlane R.J. et al. Disease-modifying osteoarthritis drugs: in vitro and in vivo data on the development of DMOADs under investigation. Expert Opin Investig Drugs. 2013;22(4):423–441. DOI: 10.1517/13543784.2013.770837.
20. Russnes H.G., Lingjærde O.C., Børresen-Dale A.L., Caldas C. Breast Cancer Molecular Stratification: From Intrinsic Subtypes to Integrative Clusters. Am J Pathol. 2017;187(10):2152–2162. DOI: 10.1016/j.ajpath.2017.04.022.
21. Maricar N., Parkes M.J., Callaghan M.J. et al. Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis. Arthritis Res Ther. 2017;19(1):88. DOI: 10.1186/s13075-017-1292-2.
22. Roubille C., Martel-Pelletier J., Raynauld J.P. et al. Meniscal extrusion promotes knee osteoarthritis structural progression: protective effect of strontium ranelate treatment in a phase III clinical trial. Arthritis Res Ther. 2015;17(1):82. DOI: 10.1186/s13075-015-0579-4.
23. Haugen I.K., Slatkowsky-Christensen B., Bøyesen P. et al. MRI findings predict radiographic progression and development of erosions in hand osteoarthritis. Ann Rheum Dis. 2016;75(1):117–123. DOI: 10.1136/annrheumdis-2014-205949.
24. Roemer F.W., Kwoh C.K., Fujii T. et al. From early radiographic knee osteoarthritis to joint arthroplasty: determinants of structural progression and symptoms. Arthritis Care Res (Hoboken). 2018;70(12):1778–1786. DOI: 10.1002/acr.23545.
25. Fatimah N., Salim B., Raja E.U., Nasim A. Predictors of response to intra-articular steroid injections in patients with osteoarthritis of the knee joint. Clin Rheumatol. 2016;35(10):2541–2547. DOI: 10.1007/s10067-016-3365-z.
26. Collins J.E., Deshpande B.R., Katz J.N., Losina E. Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2016;68(7):965–973. DOI: 10.1002/acr.22771.
27. Logerstedt D.S., Zeni J.Jr., Snyder-Mackler L. Sex differences in patients with different stages of knee osteoarthritis. Arch Phys Med Rehabil. 2014;95(12):2376–2381. DOI: 10.1016/j.apmr.2014.07.414.
28. Roman-Blas J.A., Castañeda S., Largo R., Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis Res Ther. 2009;11(5):241. DOI: 10.1186/ar2791.
29. Jung J.H., Bang C.H., Song G.G. et al. Knee osteoarthritis and menopausal hormone therapy in postmenopausal women: a nationwide cross-sectional study. Menopause. 2018;26(6):598–602. DOI: 10.1097/GME.
30. Sun M.M., Beier F., Ratneswaran A. Nuclear receptors as potential drug targets in osteoarthritis. Curr Opin Pharmacol. 2018;40:81–86. DOI: 10.1016/j.coph.2018.03.008.
31. Schott E.M., Farnsworth C.W., Grier A. et al. Targeting the gut microbiome to treat the osteoarthritis of obesity. JCI Insight. 2018;3(8):e95997. DOI: 10.1172/jci.insight.95997.
32. Hart H.F., Gross K.D., Crossley K.M. et al. Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The multicenter osteoarthritis study. Arthritis Care Res (Hoboken). 2020;72(1):107–113. DOI: 10.1002/acr.23864.
33. Ackerman I.N, Bohensky M.A., Kemp J.L., de Steiger R. Likelihood of knee replacement surgery up to 15 years after sports injury: a population-level data linkage study. J Sci Med Sport. 2018;22(6):629–634. DOI: 10.1016/j.jsams.2018.12.010.
34. Gelber A.C., Hochberg M.C., Mead L.A. et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133(5):321–328. DOI: 10.7326/0003-4819-133-5-200009050-00007.
35. McAlindon T.E., LaValley M.P., Harvey W.F. et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. DOI: 10.1001/jama.2017.5283.
36. Lapane K.L., Yang S., Driban J.B. et al. Effects of prescription nonsteroidal antiinflammatory drugs on symptoms and disease progression among patients with knee osteoarthritis. Arthritis Rheumatol. 2015;67(3):724–732. DOI: 10.1002/art.38933.
37. Karsdal M.A., Michaelis M., Ladel C. et al. Disease-modifying treatments for osteoarthritis (DMOADs) of the knee and hip: lessons learned from failures and opportunities for the future. Osteoarthritis Cartilage. 2016;24(12):2013–2021. DOI: 10.1016/j.joca.2016.07.017.
38. Loeser R.F., Goldring S.R., Scanzello C.R., Goldring M.B. Osteoarthritis: a disease of the joint as an organ. Arthritis Rheum. 2012;64(6):1697–1707. DOI: 10.1002/art.34453.
39. Styrkarsdottir U., Lund S.H., Thorleifsson G. et al. Meta-analysis of Icelandic and UK data sets identifies missense variants in SMO, IL11, COL11A1 and 13 more new loci associated with osteoarthritis. Nat Genet. 2018;50(12):1681–1687. DOI: 10.1038/s41588-018-0247-0.
40. Zengini E., Hatzikotoulas K., Tachmazidou I. et al. Genome-wide analyses using UK Biobank data provide insights into the genetic architecture of osteoarthritis. Nat Genet. 2018;50(4):549–558. DOI: 10.1038/s41588-018-0079-y.
41. Wandel S., Jüni P., Tendal B. et al. Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010;341:c4675. DOI: 10.1136/bmj.c4675.
42. Инструкция по медицинскому применению лекарственного препарата АРТРА® (Электронный ресурс.) URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=d7ea8507–4107–4361–9f8a-9a3a1d3151a4 (дата обращения: 25.06.2022). [Instructions for the medical use of the drug ARTRA® (Electronic resource.) URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=d7ea8507–4107–4361–9f8a-9a3a1d3151a4 (access date: 06.25.2022) (in Russ.)].
43. Hochberg M.C., Martel-Pelletier J., Monfort J.M.C. et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2016;75(1):37–44. DOI: 10.1136/annrheumdis-2014-206792.
44. Das A.Jr., Hammad T.A. Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis. Osteoarthritis Cartilage. 2000;8(5):343–350. DOI: 10.1053/joca.1999.0308.
45. Clegg D.O., Reda D.J., Harris C.L. et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006;354(8):795–808. DOI: 10.1056/NEJMoa052771.
46. Stellavato A., Restaino O.F., Vassallo V. et al. Comparative Analyses of Pharmaceuticals or Food Supplements Containing Chondroitin Sulfate: Are Their Bioactivities Equivalent? Adv Ther. 2019;36(11):3221–3237. DOI: 10.1007/s12325-019-01064-8.
47. Lubis A.M.T., Siagian C., Wonggokusuma E. Comparison of Glucosamine-Chondroitin Sulfate with and without Methylsulfonylmethane in Grade I-II Knee Osteoarthritis: A Double Blind Randomized Controlled Trial. Acta Med Indones. 2017;49(2):105–111. PMID: 28790224.
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