Known molecules — new approaches to treatment of osteoarthritis
DOI: 10.32364/2587-6821-2026-10-3-7
Known molecules — new approaches to treatment of osteoarthritis
L.I. Alekseeva1,2
1V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
2Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
Osteoarthritis (OA) is the most common disease among the entire range of rheumatic diseases. OA is characterized by joint pain, motor deficit, and difficulty in daily activities leading to deteriorated quality of life, disability, and, as a result, higher economic expenditures for both a patient and a country as a whole. Drug therapy is the most common treatment method whose main goals are to reduce pain, to improve functional state of joints and to ameliorate patients' quality of life. For these purposes, oral and topical nonsteroidal anti-inflammatory drugs, some analgesics, intra-articular preparations and symptomatic delayed-release drugs are used. The review presents data on modern drug therapy of OA in terms of evidence-based medicine. It emphasizes importance of symptomatic delayed-release drugs considering their symptomatic, structure-modifying and pleiotropic effects. The paper demonstrates data on domestic drugs of this group (i.e. glucosamine sulfate (GS) for intramuscular and patented intra-articular use and bioactive small marine fish extract) along with analysis of their efficacy and safety.
Keywords: osteoarthritis, gonarthrosis, coxarthrosis, glucosamine sulfate, chondroitin sulfate, efficacy, safety.
For citation: Alekseeva L.I. Known molecules — new approaches to treatment of osteoarthritis. Russian Medical Inquiry. 2026;10(3):153–159 (in Russ.). DOI: 10.32364/2587-6821-2026-10-3-7
About the author:
Lyudmila I. Alekseeva — Dr. Sc. (Med.), Head of the Department of Metabolic Diseases of Bones and Joints, Scientific Research Institute of Rheumatology named after V.A. Nasonova; 34, Kashirskoe road, Moscow, 115522, Russian Federation; Professor of the Department of Rheumatology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0001-7017-0898
Contact information: Lyudmila I. Alekseeva, e-mail: dr.alekseeva@gmail.com
Source of funding: this article was published with the support of Ellara LLC.
There is no conflict of interest.
Received 13.01.2026.
Revised 03.02.2026.
Accepted 25.02.2026.
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2. Li X.X., Cao F., Zhao C.N. et al. Global burden of osteoarthritis: Prevalence and temporal trends from 1990 to 2019. Int J Rheum Dis. 2024;27(8):e15285. DOI: 10.1111/1756-185X.15285
3. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133–2161. DOI: 10.1016/S0140-6736(24)00757-8
4. Hsu C.E., Tsai M.H., Wu H.T. et sl. Phenotype-considered kinematically aligned total knee arthroplasty for windswept-deformity-associated osteoarthritis: surgical strategy and clinical outcomes. Knee Surg Relat Res. 2024;36(1):16. DOI: 10.1186/s43019-024-00220-x
5. Allen K.D., Thoma L.M., Golightly Y.M. Epidemiology of osteoarthritis. Osteoarthritis Cartilage. 2022;30(2):184–195. DOI: 10.1016/j.joca.2021.04.020
6. Галушко Е.А., Большакова Т.Ю., Виноградова И.Б. и др. Структура ревматических заболеваний среди взрослого населения России по данным эпидемиологического исследования (предварительные результаты). Научно–практическая ревматология. 2009;1:11–17.Galushko E.A., Bolshakova T.Yu., Vinogradova I.B. et al. The structure of rheumatic diseases among the adult population of Russia according to the data of an epidemiological study (preliminary results). Scientific and practical rheumatology. 2009;1:11–17 (in Russ.).
7. Чилилов А.М., Михайлова Ю.В., Зеленова О.В. и др. Эпидемиология остеоартрозов в Российской Федерации и прогноз ее развития в постковидный период. Социальные аспекты здоровья населения (сетевое издание). 2025;71(2):21. DOI: 10.21045/2071-5021-2025-71-2-21Chililov A.M., Mikhailova Yu.V., Zelenova O.V. et al. Epidemiology of osteoarthrosis in the Russian Federation and prognosis of its development in the post-COVID period. Social aspects of population health (online publication). 2025;71(2):21 (in Russ.). DOI: 10.21045/2071-5021-2025-71-2-21
8. 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
9. Лила А.М., Алексеева Л.И., Таскина Е.А., Кашеварова Н.Г. Остеоартрит как междисциплинарная проблема: алгоритм лечения для терапевтов и врачей общей практики. Современная ревматология. 2021;15(5):68–75. DOI: 10.14412/1996-7012-2021-5-68-75Lila A.M., Alekseeva L.I., Taskina E.A., Kashevarova N.G. Osteoarthritis as an interdisciplinary problem: treatment algorithm for physicians and general practitioners. Modern Rheumatology Journal. 2021;15(5):68–75 (in Russ.). DOI: 10.14412/1996-7012-2021-5-68-75
10. Domper Arnal M.J., Hijos-Mallada G., Lanas A. Gastrointestinal and cardiovascular adverse events associated with NSAIDs. Expert Opin Drug Saf. 2022;21(3):373–384. DOI: 10.1080/14740338.2021.1965988
11. Marsico F., Paolillo S., Filardi P.P. NSAIDs and cardiovascular risk. J Cardiovasc Med (Hagerstown). 2017;18 Suppl 1: Special Issue on The State of the Art for the Practicing Cardiologist: The 2016 Conoscere E Curare Il Cuore (CCC) Proceedings from the CLI Foundation:e40-e43. DOI: 10.2459/JCM.0000000000000443
12. Rabade A., Viswanatha G.L., Nandakumar K., Kishore A. Evaluation of efficacy and safety of glucosamine sulfate, chondroitin sulfate, and their combination regimen in the management of knee osteoarthritis: a systematic review and meta-analysis. Inflammopharmacology. 2024;32(3):1759–1775. DOI: 10.1007/s10787-024-01460-9
13. Domínguez Vera P.A., Carrasco Páez L. Controversy about the use and financing of SYSADOA for osteoarthritis in Spain: An analysis of the scientific-social debate in the media. Reumatol Clin (Engl Ed). 2024;20(8):416–422. DOI: 10.1016/j.reumae.2024.09.003
14. Volpi N. Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. J Pharm Pharmacol. 2009;61(10):1271–1280. DOI: 10.1211/jpp/61.10.0002
15. Yang W., Sun C., He S.Q. et al. The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis-a Systematic Review and Network Meta-Analysis. J Gen Intern Med. 2021;36(7):2085–2093. DOI: 10.1007/s11606-021-06755-z
16. King D.E., Xiang J. Glucosamine/Chondroitin and Mortality in a US NHANES Cohort. J Am Board Fam Med. 2020;33(6):842–847. DOI: 10.3122/jabfm.2020.06.200110
17. Partridge L., Fuentealba M., Kennedy B.K. The quest to slow ageing through drug discovery. Nat Rev Drug Discov. 2020;19(8):513–532. DOI: 10.1038/s41573-020-0067-7
18. Kantor E.D., Lampe J.W., Vaughan T.L. et al. Association between use of specialty dietary supplements and C-reactive protein concentrations. Am J Epidemiol. 2012;176(11):1002–1013. DOI: 10.1093/aje/kws186
19. Navarro S.L., Herrero M., Martinez H. et al. Differences in Serum Biomarkers Between Combined Glucosamine and Chondroitin Versus Celecoxib in a Randomized, Double-blind Trial in Osteoarthritis Patients. Antiinflamm Antiallergy Agents Med Chem. 2020;19(2):190–201. DOI: 10.2174/1871523018666190115094512
20. Biver E., Berenbaum F., Valdes A.M. et al. Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Ageing Res Rev. 2019;55:100946. DOI: 10.1016/j.arr.2019.100946
21. Shmagel A., Demmer R., Knights D. et al. The Effects of Glucosamine and Chondroitin Sulfate on Gut Microbial Composition: A Systematic Review of Evidence from Animal and Human Studies. Nutrients. 2019;11(2):294. DOI: 10.3390/nu11020294
22. 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
23. Hochberg M.C., Martel-Pelletier J., Monfort J. 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
24. Raynauld J.P., Martel-Pelletier J., Dorais M. et al. Total Knee Replacement as a Knee Osteoarthritis Outcome: Predictors Derived from a 4-Year Long-Term Observation following a Randomized Clinical Trial Using Chondroitin Sulfate. Cartilage. 2013;4(3):219–226. DOI: 10.1177/1947603513483547
25. Bruyere O., Pavelka K., Rovati L.C. et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthritis Cartilage. 2008;16(2):254–260. DOI: 10.1016/j.joca.2007.06.011
26. Gregori D., Giacovelli G., Minto C. et al. Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA. 2018;320(24):2564–2579. DOI: 10.1001/jama.2018.19319
27. Yang W., Sun C., He S.Q. et al. The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis — a Systematic Review and Network Meta-Analysis. J Gen Intern Med. 2021;36(7):2085–2093. DOI: 10.1007/s11606-021-06755-z
28. Honvo G., Reginster J.Y., Rabenda V. et al. Safety of Symptomatic Slow-Acting Drugs for Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis. Drugs Aging. 2019;36(Suppl 1):65–99. DOI: 10.1007/s40266-019-00662-z
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