Preclinical symptoms of gonarthrosis: rationale for early chondroprotective therapy


DOI: https://dx.doi.org/10.18565/therapy.2019.8.90-95

Arshin E.V., Gorshkov D.A., Radoschekin M.A., Khlynova O.V., Arshin R.E., Tuev A.V.

1) Academician E.A. Wagner Perm State medical University of the Ministry of Healthcare of Russia; 2) Medical center LLC VITA-D, Tchaikovsky City (Perm region)
Aim. To study the condition of hyaline cartilage of the knee joints in patients with high risk of gonarthrosis, but without clinical and radiological criteria of the disease. To establish the feasibility of chondroprotective therapy at the pre-clinical stage.
Material and methods. The study included 392 persons. The main group included 361 patients without clinical and radiological manifestations of gonarthrosis with high risk of this disease. Patients of this group were divided into two subgroups. The first for 2 years did not receive specific therapy, the second for 2 years took combined chondroprotective therapy. The control group included 31 persons without high risk of gonarthrosis. Initially and two years later, all conducted ultrasound examination of the knee joints. The dynamics of the minimum thickness of hyaline cartilage was analyzed.
Results. Patients who had a high risk of gonarthrosis, despite the absence of clinical and radiological signs of the disease, had a significant decrease in the minimum height of the hyaline cartilage of the knee joint relative to the control group. Patients of the second subgroup of the main group receiving combined chondroprotective therapy had significantly less decrease in the minimum thickness of hyaline cartilage in two years than patients of the first subgroup who did not receive specific therapy.
Conclusion. Structural changes in the hyaline cartilage of the knee joint are detected by ultrasonography long before the manifestation of gonarthrosis clinic and the appearance of radiological manifestations. Combined long-term chondroprotective therapy is effective at the preclinical stage of gonarthrosis.
Keywords: osteoarthritis, gonarthrosis, pre-clinical gonarthrosis, preventive therapy, chondroprotectors, chondroitin sulfate, glucosamine hydrochloride
Read entire article

Literature


  1. Беневоленская Л.И., Бржезовский М.М. Эпидемиология ревматических болезней. М.: Медицина, 1988; 237.

  2. Беневоленская Л.Н., Бржезовский М.М. Эпидемиология ревматических болезней. М.: Медицина, 1988; 240.

  3. Досин Ю.М., Ягур В.Е., Мартусевич Н.А., Лысый Б.В., Соколов В.А., Фатхи Али Аль-Бшени. Первичный гонартроз (состояние проблемы). Лечебное дело. 2013; 2(300): 74–78.

  4. Зайцева Е.М., Алексеева Л.И., Смирнов А.В., Насонов Е.Л. Магнитно-резонансная томография при остеоартрозе. Научно-практическая ревматология. 2006; 44(5): 59–75.

  5. Кабалык М.А. Распространенность остеоартрита в России: региональные аспекты динамики статистических показателей за 2011–2016 гг. Научно-практическая ревматология. 2018; 56(4): 416–422.

  6. Макарова М.В., Проклова Л.В., Яворская Г.В., Юницына А.В., Якоби А.Я., Вальков М.Ю. Насколько объективны данные ультразвукового исследования при гонартрите рентгенологической нулевой стадии. Лучевая диагностика и терапия. 2017; 4: 60–67.

  7. Макарова М.В., Агапитов А.В., Юницына А.В., Якоби А.Я., Вальков М.Ю. Ультразвуковая сонография и магнитно-резонансная томография в выявлении дегенеративных изменений при рентгенологически нулевой стадии остеоартроза коленных суставов. Вестник новых медицинских технологий. 2014; 1.

  8. Светлова М.С. Патогенетическое лечение остеоартроза коленных суставов. Современная ревматология 2012; 3: 44–45.

  9. Смирнов А.В. Рентгенологическая диагностика первичного идиопатического остеоартроза. Русский медицинский журнал 2011; 9(7–8): 294–298.

  10. Luyten F.P., Bierma-Zeinstra S., Dell’Accio F., Kraus V.B., Nakata K.F., Sekiya I., Arden N.K., Lohmander L.S. Toward classification criteria for early osteoarthritis of the knee. Seminars in Arthritis and Rheumatism. 2018; 47 (4): 457–63.

  11. Mahjoub M., Berenbaum F., Houard X. Why subchondral bone in osteoarthritis? The importance of the cartilage bone interface in osteoarthritis. Osteoporosis International. 2012; 8: 841–46.

  12. Lee Y.H., Woo J.H., Choi S.J., Ji J.D., Song G.G. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatology International. 2010; 30(3): 357–63.

  13. Martel-Pelletier J., Roubille C., Abram F., Hochberg M. C., Dorais M., Delorme P., Raynauld J.P., Pelletier J.P. 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. Annals of the Rheumatic Diseases. 2013; 74(3): 547–56.

  14. Pavelka K., Bruyere O., Cooper C., Kanis J.A., Leeb B.F., Maheu E., Pelletier J.M., Monfort J., Pelletier J.P., Rizzoli R., Reginster J.Y. Diacerein: benefits, risks and place in the management of osteoarthritis. An opinion-based report from the ESCEO. Drugs Aging. 2016; 33(2): 75–85.

  15. Verbruggen G. Chondroprotective drugs in degenerative joint diseases. Rheumatology (Oxford). 2006; 45(2): 129–38.

  16. Vos T., Allen C., Arora M., Barber R.M., Bhutta Z.A., Brown A., Chen A.Z. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016; 388(10053): 1545–602.


About the Autors

Evgeny V. Arshin, MD, professor of the Department of hospital therapy of Academician E.A. Wagner Perm State medical University of the Ministry of Healthcare of Russia. Address: 614000, Perm, 26 Petropavlovskaya Str.
Tel.: +7 (902) 638-79-00. E-mail: 1ewa1@mail.ru
Danil A. Gorshkov, PhD, candidate of the Department of hospital therapy of Academician E.A. Wagner Perm state medical university of the Ministry of Healthcare of Russia. Address: 614000, Perm, 26 Petropavlovskaya Stк.
Tel.: +7 (996) 324-86-81. E-mail: Danilgorshcov@yandex.ru
Mikhail A. Radoshchekin, applicant, general practitioner, cardiologist, rheumatologist, functional diagnostics doctor, chief doctor assistant for the examination of temporary disability and quality control of medical care of the VITA-D medical Center. Address: 617760, Perm region, Tchaikovsky, 23/3 Decabristov Str.
Olga V. Khlynova, MD, professor, corresponding member of RAS, head of the Department of hospital therapy of Academician E.A. Wagner Perm state medical university of the Ministry of Healthcare of Russia. Address: 614000, Perm, 26 Petropavlovskaya Str.
Roman E. Arshin, a student of the 209th group of the medical faculty of Academician E.A. Wagner Perm State medical University of the Ministry of Healthcare of Russia.
Alexander V. Tuev, MD, professor, academician of the Russian academy of natural sciences.

Back to Content

Бионика Медиа