Лечение хронической боли в суставах и спине комбинированными препаратами хондроитина сульфата и глюкозамина гидрохлорида

Алексеева Л.И., Шарапова Е.П. Лечение хронической боли в суставах и спине комбинированными препаратами хондроитина сульфата и глюкозамина гидрохлорида. Consilium Medicum. 2016; 18 (2): 62–67. DOI: 10.26442/2075-1753_2016.2.62-67

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Alekseeva L.I., Sharapova E.P. Treatment of chronic pain in the joints and back combined preparations of chondroitin sulfate and glucosamine hydrochloride. Consilium Medicum. 2016; 18 (2): 62–67. DOI: 10.26442/2075-1753_2016.2.62-67

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Аннотация

Лечение остеоартроза (ОА) и боли в нижней части спины (БНС) направлено в первую очередь на симптомы болезни, т.е. на уменьшение боли и улучшение функционального состояния суставов и позвоночника, которое достигается комбинацией нефармакологических и медикаментозных методов. Для снижения боли пациентам с ОА и БНС назначаются нестероидные противовоспалительные препараты (НПВП), анальгетики, миорелаксанты и другие препараты, которые не полностью устраняют симптомы. Однако на фоне приема НПВП значительно повышается риск развития нежелательных реакций со стороны желудочно-кишечного тракта, сердечно-сосудистой системы, почек и других органов, – это особенно важно при коморбидных состояниях у пожилых больных, – что может лимитировать назначение ряда препаратов. Назначение комбинации хондроитина сульфата и глюкозамина, обладающей противовоспалительной и анальгетической активностью, может быть полезно при лечении ОА и БНС с учетом роли воспаления в патогенезе БНС, а структурно-модифицирующие свойства могут реализовываться при поражении фасеточных суставов, занимающих определенное место в структуре БНС. Однако мнение по поводу применения этих препаратов, особенно хондроитина сульфата и глюкозамина, неоднозначно. В России были проведены многоцентровые открытые наблюдательные проспективные исследования эффективности данной комбинации при лечении ОА коленных суставов и неспецифической БНС в амбулаторной практике. Анализ результатов этих исследований показал достоверное уменьшение болей, скованности, улучшение функционального индекса Освестри при БНС и WOMAC – при ОА, а также снижение суточной потребности в НПВП. Также были отмечены хорошая переносимость и высокая безопасность препаратов.

Ключевые слова: остеоартроз, боли в спине, клиническая эффективность, переносимость, нежелательные явления.

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Treating osteoarthritis (OA) and pain in the lower back (LBP) directed primarily to the symptoms of the disease, i.e. to reduce pain and improve functional condition of the joints and spine, which achieved a combination of non-pharmacological and pharmacological methods. appointed by nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, muscle relaxants and other drugs, which do not completely eliminate the symptoms to reduce pain in patients with OA and LBP. However, in patients receiving NSAIDs significantly increased risk of adverse reactions fr om the gastrointestinal tract, cardiovascular system, kidneys and other organs – this is especially important when comorbid conditions in older patients – that may lim it the appointment of a number of drugs. Appointment of a combination of glucosamine and chondroitin sulfate, which has anti-inflammatory and analgesic activity may be useful in the treatment of OA and LBP with regard to the role of inflammation in the pathogenesis of LBP, and structurally modifying properties can be realized with the defeat of the facet joints, has a definite place in the structure of the BNS. However, opinions about the use of these drugs, particularly chondroitin sulfate and glucosamine, is ambiguous. In Russia it was held open multicentre observational prospective study of the effectiveness of this combination in the treatment of knee OA and non-specific LBP in outpatient practice. Analysis of the results of these studies showed a significant decrease in pain, stiffness, improved functional index at Oswestry LBP and WOMAC – in OA, as well as reducing the daily requirement of NSAIDs. There were also marked by good tolerability and high security products.

Key words: osteoarthritis, back pain, clinical efficacy, tolerability, adverse events.

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1. Nasonov E.L. Bolevoi sindrom pri patologii oporno-dvigatel'nogo apparata. Vrach. 2002; 4: 15–9. [in Russian]
2. Erdes Sh.F., Folomeeva O.M. Revmaticheskie zabolevaniia i invalidnost' vzroslogo naseleniia Rossiiskoi Federatsii. Nauchno-prakticheskaia revmatologiia. 2007; 4: 4–10. [in Russian]
3. Galushko E.A. Mediko-sotsial'naia znachimost' revmaticheskikh zabolevanii. Avtoref. dis. … d-ra med. nauk. M., 2011. [in Russian]
4. Chou R et al. Low Back Pain Guidelines Panel. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.Ann Intern Med 2007; 147: 478–91.
5. McAlindon TE, Bannuru RR, Sullivan MC et al. OARSI guidelines for thenon-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22 (3): 363–88.
6. Roelofs P, Deyo R, Koes B et al. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev 2008; 23 (1): CD000396.
7. Henrotin Y, Marty M, Mobasheri A. What is the current status of chondroitin sulfate and glucosamine for the treatment of knee osteoarthritis? Maturitas 2014; 78: 184–7.
8. Fransen M, Agaliotis M, Nair L et al. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis 2014; 74 (5): 1–8. doi:10.1136/annrheumdis-2013-203954
9. Clegg DO et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006; 354: 795–808.
10. Jomphe C, Gabriac M, Hale TM et al. Chondroitin Sulfate Inhibits the Nuclear Translocation of Nuclear Factor-κB in Interleukin-1β-Stimulated Chondrocytes. Basic Clin Pharmacol Toxicol 2007; 102: 59–65.
11. Martel-Pelletier J 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 2013-203906, doi: 10.1136/annrheumdis-2013-203906 (2013).
12. Hochbergy MC et al. The Multicentric Osteoarthritis intervention Study with Sysadoa (MOVES). MOVES Steering Committee. Osteoarthritis Cartilage 2014; 22: S7–S56.
13. Alekseeva L.I., Chichasova N.V., Mendel' O.I. Ratsional'nyi vybor bazisnoi terapii pri osteoartroze. Rezul'taty otkrytogo randomizirovannogo mnogotsentrovogo issledovaniia preparata ARTRAR v Rossii. RMZh. 2005; 13 (24): 1637–40. [in Russian]
14. Kocsis JJ, Harkaway S, Snyder R. Biological effects of the metabolites of dimethyl sulfoxide. Ann N Y Acad Sci 1975; 243: 104–9.
15. Murav'ev IuV, Venikova MS, Pleskovskaia GN et al. Effect of dimethyl sulfoxide and dimethyl sulfone on a destructive process in the joints of mice with spontaneous arthritis. Patol Fiziol Eksp Ter 1991; 2: 37–9.
16. Engelke UF, Tangerman A, Willemsen MA et al. Dimethyl sulfone in human cerebrospinal fluid and blood plasma confirmed by onedimensional (1)H and two-dimensional (1)H-(13)C NMR. NMR Biomed 2005; 18: 331–6.
17. Ebisuzaki K. Aspirin and methylsulfonylmethane (MSM): a search for common mechanisms, with implications for cancer prevention. Anticancer Res 2003; 23: 453–8.
18. Alam SS, Layman DL. Dimethyl sulfoxide inhibition of prostacyclin production in cultured aortic endothelial cells. Ann N Y Acad Sci 1983; 411: 318–20.
19. Beilke MA, Collins-Lech C, Sohnle PG. Effects of dimethyl sulfoxide on the oxidative function of human neutrophils. J Lab Clin Med 1987; 110: 91–6.
20. Usha P, Naidu M. Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. Clin Drug Invest 2004; 24: 353–63.
21. Kim LS, Axelrod LJ, Howard P et al. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage 2006; 14: 286–94.
22. Pagonis TA, Givissis PK, Kritis AC, Christodoulou AC. The Effect of Methylsulfonylmethane on Osteoarthritic Large Joints and Mobility. Int J of Orthopaedics 2014; 1 (1): 19–24.
23. Vidyasagar S, Mukhyaprana P, Shashikiran U et al. Efficacy and Tolerability of Glucosamine Chondroitin Sulphate – Methyl Sulfonyl Methane (MSM) in Osteoarthritis of Knee in Indian Patients. IJPT 2004; 3: 61–5.

Авторы

Л.И.Алексеева*, Е.П.Шарапова

ФГБНУ Научно-исследовательский институт ревматологии им. В.А.Насоновой. 115522, Россия, Москва, Каширское ш., д. 34А
*alekseeva@irramn.ru

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L.I.Alekseeva*, E.P.Sharapova

V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34A
*alekseeva@irramn.ru

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