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Медленно действующие симптоматические средства в терапии остеоартроза
Погожева Е.Ю., Амирджанова В.Н. Медленно действующие симптоматические средства в терапии остеоартроза. Consilium Medicum. 2017; 19 (2): 152–156.
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Pogozheva E.Yu., Amirdzhanova V.N. Slow acting symptomatic agents in the therapy of osteoarthritis. Consilium Medicum. 2017; 19 (2): 152–156.
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Аннотация
В статье представлены определение остеоартроза (ОА), основные проявления заболевания, отмечены проблемы терапии ОА, приведен алгоритм ведения пациентов с ОА, подчеркивается важность образовательных программ, сочетания фармакологических и нефармакологических методов лечения, описан подход к назначению обезболивающей терапии. Обсуждается применение медленно действующих симптоматических средств, обладающих высокой безопасностью, симптоммодифицирующим и потенциальным структурно-модифицирующим действием. Представлены данные об особенностях механизма действия, клинической эффективности и безопасности хондроитина сульфата, глюкозамина и их комбинации. Приведены данные клинических исследований препарата Артра®, показана его эффективность в отношении болевого синдрома и улучшения функции суставов у пациентов с ОА, отмечены хорошая безопасность и переносимость препарата, а также его способность сохранять эффект после окончания терапии.
Ключевые слова: остеоартроз, медленно действующие симптоматические средства, хондроитина сульфат, глюкозамин, Артра.
Ключевые слова: остеоартроз, медленно действующие симптоматические средства, хондроитина сульфат, глюкозамин, Артра.
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The article presents the definition of osteoarthritis (OA), the main manifestations of the disease, the problems of OA therapy, the algorithm for managing patients with OA, the importance of educational programs, the combination of pharmacological and non-pharmacological methods of treatment, and the approach to prescribing analgesic therapy. The use of slow-acting symptomatic agents with high safety, symptom-modifying and potential structural-modifying action is discussed. Data on the features of the mechanism of action, clinical efficacy and safety of chondroitin sulfate, glucosamine and their combination are presented. The data of clinical trials of the preparation Arthra® is presented, its effectiveness in relation to pain syndrome and joint function improvement in patients with OA is shown, the safety and tolerability of the drug are noted, as well as its ability to preserve the effect after the end of therapy.
Key words: osteoarthritis, slow acting symptomatic means, chondroitin sulfate, glucosamine, Arthra.
Key words: osteoarthritis, slow acting symptomatic means, chondroitin sulfate, glucosamine, Arthra.
Полный текст
Список литературы
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5. Bruyеre O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014; 44 (3): 253–63.
6. Persiani S, Rotini R, Trisolino G et al. Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose. Osteoarthritis Cartilage 2007; 15 (7): 764–72.
7. Persiani S, Roda E, Rovati LC et al. Glucosamine oral bioavailability and plasma pharmacokinetics after increasing doses of crystalline glucosamine sulfate in man. Osteoarthritis Cartilage 2005; 13 (12): 1041–9.
8. Derfoul A, Miyoshi AD, Freeman DE, Tuan RS. Glucosamine promotes chondrogenic phenotype in both chondrocytes and mesenchymal stem cells and inhibits MMP-13 expression and matrix degradation. Osteoarthritis Cartilage 2007; 15 (6): 646–55.
9. Varghese S, Theprungsirikul P, Sahani S et al. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression. Osteoarthritis Cartilage 2007; 15 (1): 59–68.
10. Kim MM, Mendis E, Rajapakse N, Kim SK. Glucosamine sulfate promotes osteoblastic differentiation of MG-63 cells via anti-inflammatory effect. Bioorg Med Chem Lett 2007; 17 (7): 1938–42.
11. Mendis E, Kim MM, Rajapakse N, Kim SK. Sulfated glucosamine inhibits oxidation of biomolecules in cells via a mechanism involving intracellular free radical scavenging. Eur J Pharmacol 2008; 579 (1–3): 74–85.
12. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283 (11): 1469–75.
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14. Towheed TE, Maxwell L, Anastassiades TP et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005 (2): CD002946.
15. Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Ann Pharmacother 2005; 39 (6): 1080–7.
16. Bruyere O, Pavelka K, Rovati LC 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): 254–60.
17. Volpi N. Therapeutic applications of glycosaminoglycans. Curr Med Chem 2006; 13 (15): 1799–810.
18. Leeb BF, Schweitzer H, Montag K et al. A Metaanalysis of Chondroitin Sulphate in the Treatment of Osteoarthritis. J Rheum 2000; 27: 205–11.
19. Uebelhart D, Malaise V, Marcolongo R et al. Intermittent treatment of knee osteoarthritis with oral chondriitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 2004; 12: 269–76.
20. Kahan A, Uebelhart D, De Vathaire F. Long-term effects of chondroitins 4 and 6 sulfateon knee osteoarthritis: The study on osteoarthritis progression prevention, a twoyear,randomized, double-blind, placebo-controlled trial. Arthr Rheum 2009; 60 (2): 524–33.
21. Hochberg MC, Martel-Pelletier J, Monfort J et al. MOVES Investigation Group. 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.
22. Fransen M, Agaliotis M, Nairn L et al. Glucosamine and chondroitin for knee placebo-controlled clinical trial evaluating osteoarthritis: a double-blind randomizedsingle and combination regimens. Ann Rheum Dis 2015; 74 (5): 851–8.
23. 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): 547–56.
24. Raynauld JP, Pelletier JP, Abram F et al. Long-Term Effects of Glucosamine and Chondroitin Sulfate on the Progression of Structural Changes in Knee Osteoarthritis: Six-Year Followup Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 68 (10): 1560–6.
25. Алексеева Л.И., Чичасова Н.В., Мендель О.И. и др. Рациональный выбор базисной терапии при остеоартрозе. Результаты открытого рандомизированного многоцентрового исследования препарата АРТРА® в России. РМЖ. 2005; 24: 1637–40. / Alekseeva L.I., Chichasova N.V., Mendel' O.I. i dr. Ratsional'nyi vybor bazisnoi terapii pri osteoartroze. Rezul'taty otkrytogo randomizirovannogo mnogotsentrovogo issledovaniia preparata ARTRA® v Rossii. RMZh. 2005; 24: 1637–40. [in Russian]
26. Светлова М.С. Эффективность препарата «Артра» в лечении остеоартроза (ОА). Научно-практич. ревматология. 2006; 2: 109. / Svetlova M.S. Effektivnost' preparata «Artra» v lechenii osteoartroza (OA). Nauchno-praktich. revmatologiia. 2006; 2: 109. [in Russian]
27. Родионова С.С., Еськин Н.А. комбинация хондроитина сульфата и глюкозамина (препарат Артра) для купирования боли и снижении потребления нестероидных противовоспалительных препаратов у пациентов с I–II стадиями остеоартроза коленных суставов. Хирургия. Журнал им. Н.И.Пирогова. 2016; 1: 67–72. / Rodionova S.S., Es'kin N.A. kombinatsiia khondroitina sul'fata i gliukozamina (preparat Artra) dlia kupirovaniia boli i snizhenii potrebleniia nesteroidnykh protivovospalitel'nykh preparatov u patsientov s I–II stadiiami osteoartroza kolennykh sustavov. Khirurgiia. Zhurnal im. N.I.Pirogova. 2016; 1: 67–72. [in Russian]
28. Майко О.Ю., Савелова Е.Е. Клиническая эффективность хондроитин сульфата и его комбинации с глюкозамина гидрохлоридом при лечении гонартроза и коксартроза в условиях поликлиники. Клиническая геронтология. 2016; 22 (5–6): 18–25. / Maiko O.Yu., Savelova E.E. Klinicheskaia effektivnost' khondroitin sul'fata i ego kombinatsii s gliukozamina gidrokhloridom pri lechenii gonartroza i koksartroza v usloviiakh polikliniki. Klinicheskaia gerontologiia. 2016; 22 (5–6): 18–25. [in Russian]
2. Насонов Е.Л. Ревматология. Клинические рекомендации. М.: ГЭОТАР-Медиа, 2005; с. 264. / Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR-Media, 2005; s. 264. [in Russian]
3. Jordan KM, Arden NK, 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: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyеre O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014; 44 (3): 253–63.
6. Persiani S, Rotini R, Trisolino G et al. Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose. Osteoarthritis Cartilage 2007; 15 (7): 764–72.
7. Persiani S, Roda E, Rovati LC et al. Glucosamine oral bioavailability and plasma pharmacokinetics after increasing doses of crystalline glucosamine sulfate in man. Osteoarthritis Cartilage 2005; 13 (12): 1041–9.
8. Derfoul A, Miyoshi AD, Freeman DE, Tuan RS. Glucosamine promotes chondrogenic phenotype in both chondrocytes and mesenchymal stem cells and inhibits MMP-13 expression and matrix degradation. Osteoarthritis Cartilage 2007; 15 (6): 646–55.
9. Varghese S, Theprungsirikul P, Sahani S et al. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression. Osteoarthritis Cartilage 2007; 15 (1): 59–68.
10. Kim MM, Mendis E, Rajapakse N, Kim SK. Glucosamine sulfate promotes osteoblastic differentiation of MG-63 cells via anti-inflammatory effect. Bioorg Med Chem Lett 2007; 17 (7): 1938–42.
11. Mendis E, Kim MM, Rajapakse N, Kim SK. Sulfated glucosamine inhibits oxidation of biomolecules in cells via a mechanism involving intracellular free radical scavenging. Eur J Pharmacol 2008; 579 (1–3): 74–85.
12. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283 (11): 1469–75.
13. Richy F, Bruyere O, Ethgen O et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003; 163 (13): 1514–22.
14. Towheed TE, Maxwell L, Anastassiades TP et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005 (2): CD002946.
15. Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Ann Pharmacother 2005; 39 (6): 1080–7.
16. Bruyere O, Pavelka K, Rovati LC 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): 254–60.
17. Volpi N. Therapeutic applications of glycosaminoglycans. Curr Med Chem 2006; 13 (15): 1799–810.
18. Leeb BF, Schweitzer H, Montag K et al. A Metaanalysis of Chondroitin Sulphate in the Treatment of Osteoarthritis. J Rheum 2000; 27: 205–11.
19. Uebelhart D, Malaise V, Marcolongo R et al. Intermittent treatment of knee osteoarthritis with oral chondriitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 2004; 12: 269–76.
20. Kahan A, Uebelhart D, De Vathaire F. Long-term effects of chondroitins 4 and 6 sulfateon knee osteoarthritis: The study on osteoarthritis progression prevention, a twoyear,randomized, double-blind, placebo-controlled trial. Arthr Rheum 2009; 60 (2): 524–33.
21. Hochberg MC, Martel-Pelletier J, Monfort J et al. MOVES Investigation Group. 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.
22. Fransen M, Agaliotis M, Nairn L et al. Glucosamine and chondroitin for knee placebo-controlled clinical trial evaluating osteoarthritis: a double-blind randomizedsingle and combination regimens. Ann Rheum Dis 2015; 74 (5): 851–8.
23. 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): 547–56.
24. Raynauld JP, Pelletier JP, Abram F et al. Long-Term Effects of Glucosamine and Chondroitin Sulfate on the Progression of Structural Changes in Knee Osteoarthritis: Six-Year Followup Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 68 (10): 1560–6.
25. Алексеева Л.И., Чичасова Н.В., Мендель О.И. и др. Рациональный выбор базисной терапии при остеоартрозе. Результаты открытого рандомизированного многоцентрового исследования препарата АРТРА® в России. РМЖ. 2005; 24: 1637–40. / Alekseeva L.I., Chichasova N.V., Mendel' O.I. i dr. Ratsional'nyi vybor bazisnoi terapii pri osteoartroze. Rezul'taty otkrytogo randomizirovannogo mnogotsentrovogo issledovaniia preparata ARTRA® v Rossii. RMZh. 2005; 24: 1637–40. [in Russian]
26. Светлова М.С. Эффективность препарата «Артра» в лечении остеоартроза (ОА). Научно-практич. ревматология. 2006; 2: 109. / Svetlova M.S. Effektivnost' preparata «Artra» v lechenii osteoartroza (OA). Nauchno-praktich. revmatologiia. 2006; 2: 109. [in Russian]
27. Родионова С.С., Еськин Н.А. комбинация хондроитина сульфата и глюкозамина (препарат Артра) для купирования боли и снижении потребления нестероидных противовоспалительных препаратов у пациентов с I–II стадиями остеоартроза коленных суставов. Хирургия. Журнал им. Н.И.Пирогова. 2016; 1: 67–72. / Rodionova S.S., Es'kin N.A. kombinatsiia khondroitina sul'fata i gliukozamina (preparat Artra) dlia kupirovaniia boli i snizhenii potrebleniia nesteroidnykh protivovospalitel'nykh preparatov u patsientov s I–II stadiiami osteoartroza kolennykh sustavov. Khirurgiia. Zhurnal im. N.I.Pirogova. 2016; 1: 67–72. [in Russian]
28. Майко О.Ю., Савелова Е.Е. Клиническая эффективность хондроитин сульфата и его комбинации с глюкозамина гидрохлоридом при лечении гонартроза и коксартроза в условиях поликлиники. Клиническая геронтология. 2016; 22 (5–6): 18–25. / Maiko O.Yu., Savelova E.E. Klinicheskaia effektivnost' khondroitin sul'fata i ego kombinatsii s gliukozamina gidrokhloridom pri lechenii gonartroza i koksartroza v usloviiakh polikliniki. Klinicheskaia gerontologiia. 2016; 22 (5–6): 18–25. [in Russian]
________________________________________________
1. Revmatologiia. Klinicheskie rekomendatsii. Pod red. E.L.Nasonova. M.: GEOTAR-Media, 2010; s. 326. [in Russian]
2. Nasonov E.L. Revmatologiia. Klinicheskie rekomendatsii. M.: GEOTAR-Media, 2005; s. 264. [in Russian]
3. Jordan KM, Arden NK, 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: 1145–55.
4. Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis. Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010; 18: 476–99.
5. Bruyеre O, Cooper C, Pelletier J-P et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally. A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum 2014; 44 (3): 253–63.
6. Persiani S, Rotini R, Trisolino G et al. Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose. Osteoarthritis Cartilage 2007; 15 (7): 764–72.
7. Persiani S, Roda E, Rovati LC et al. Glucosamine oral bioavailability and plasma pharmacokinetics after increasing doses of crystalline glucosamine sulfate in man. Osteoarthritis Cartilage 2005; 13 (12): 1041–9.
8. Derfoul A, Miyoshi AD, Freeman DE, Tuan RS. Glucosamine promotes chondrogenic phenotype in both chondrocytes and mesenchymal stem cells and inhibits MMP-13 expression and matrix degradation. Osteoarthritis Cartilage 2007; 15 (6): 646–55.
9. Varghese S, Theprungsirikul P, Sahani S et al. Glucosamine modulates chondrocyte proliferation, matrix synthesis, and gene expression. Osteoarthritis Cartilage 2007; 15 (1): 59–68.
10. Kim MM, Mendis E, Rajapakse N, Kim SK. Glucosamine sulfate promotes osteoblastic differentiation of MG-63 cells via anti-inflammatory effect. Bioorg Med Chem Lett 2007; 17 (7): 1938–42.
11. Mendis E, Kim MM, Rajapakse N, Kim SK. Sulfated glucosamine inhibits oxidation of biomolecules in cells via a mechanism involving intracellular free radical scavenging. Eur J Pharmacol 2008; 579 (1–3): 74–85.
12. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000; 283 (11): 1469–75.
13. Richy F, Bruyere O, Ethgen O et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003; 163 (13): 1514–22.
14. Towheed TE, Maxwell L, Anastassiades TP et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005 (2): CD002946.
15. Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Ann Pharmacother 2005; 39 (6): 1080–7.
16. Bruyere O, Pavelka K, Rovati LC 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): 254–60.
17. Volpi N. Therapeutic applications of glycosaminoglycans. Curr Med Chem 2006; 13 (15): 1799–810.
18. Leeb BF, Schweitzer H, Montag K et al. A Metaanalysis of Chondroitin Sulphate in the Treatment of Osteoarthritis. J Rheum 2000; 27: 205–11.
19. Uebelhart D, Malaise V, Marcolongo R et al. Intermittent treatment of knee osteoarthritis with oral chondriitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. Osteoarthritis Cartilage 2004; 12: 269–76.
20. Kahan A, Uebelhart D, De Vathaire F. Long-term effects of chondroitins 4 and 6 sulfateon knee osteoarthritis: The study on osteoarthritis progression prevention, a twoyear,randomized, double-blind, placebo-controlled trial. Arthr Rheum 2009; 60 (2): 524–33.
21. Hochberg MC, Martel-Pelletier J, Monfort J et al. MOVES Investigation Group. 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.
22. Fransen M, Agaliotis M, Nairn L et al. Glucosamine and chondroitin for knee placebo-controlled clinical trial evaluating osteoarthritis: a double-blind randomizedsingle and combination regimens. Ann Rheum Dis 2015; 74 (5): 851–8.
23. 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): 547–56.
24. Raynauld JP, Pelletier JP, Abram F et al. Long-Term Effects of Glucosamine and Chondroitin Sulfate on the Progression of Structural Changes in Knee Osteoarthritis: Six-Year Followup Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2016; 68 (10): 1560–6.
25. Alekseeva L.I., Chichasova N.V., Mendel' O.I. i dr. Ratsional'nyi vybor bazisnoi terapii pri osteoartroze. Rezul'taty otkrytogo randomizirovannogo mnogotsentrovogo issledovaniia preparata ARTRA® v Rossii. RMZh. 2005; 24: 1637–40. [in Russian]
26. Svetlova M.S. Effektivnost' preparata «Artra» v lechenii osteoartroza (OA). Nauchno-praktich. revmatologiia. 2006; 2: 109. [in Russian]
27. Rodionova S.S., Es'kin N.A. kombinatsiia khondroitina sul'fata i gliukozamina (preparat Artra) dlia kupirovaniia boli i snizhenii potrebleniia nesteroidnykh protivovospalitel'nykh preparatov u patsientov s I–II stadiiami osteoartroza kolennykh sustavov. Khirurgiia. Zhurnal im. N.I.Pirogova. 2016; 1: 67–72. [in Russian]
28. Maiko O.Yu., Savelova E.E. Klinicheskaia effektivnost' khondroitin sul'fata i ego kombinatsii s gliukozamina gidrokhloridom pri lechenii gonartroza i koksartroza v usloviiakh polikliniki. Klinicheskaia gerontologiia. 2016; 22 (5–6): 18–25. [in Russian]
Авторы
Е.Ю.Погожева, В.Н.Амирджанова*
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34а
*lifequality@yandex.ru
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А.Насоновой». 115522, Россия, Москва, Каширское ш., д. 34а
*lifequality@yandex.ru
________________________________________________
E.Yu.Pogozheva, V.N.Amirdzhanova*
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34a
*lifequality@yandex.ru
V.A.Nasonova Research Institute of Rheumatology. 115522, Russian Federation, Moscow, Kashirskoe sh., d. 34a
*lifequality@yandex.ru
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