R.I. SADYKOV, I.F. AKHTYAMOV, S.A. LAPSHINA, K.T. SHOSHORINA

 Kazan State Medical University, Kazan

  Contact details:

Sadykov R.I. — Assistant Lecturer of the Department of Traumatology, Orthopedics and Surgery of Extreme States

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-917-253-61-46, e-mail: rustiksadykov@mail.ru

 Gonarthrosis is a chronic degenerative-inflammatory disease of the knee joint in which all components of the joint are affected. In current clinical guidelines for the treatment of osteoarthritis of the knee, the first step in therapy is the prescription of symptom-modifying drugs with delayed action. One of the most well-studied and effective of these drugs is chondroitin sulfate. A promising remedy for the treatment of gonarthrosis is intra-articular injections, primarily of high-molecular-weight hyaluronic acid preparations, which have proven effective in clinical practice. Their use at an early stage of the disease can contribute to a more complete implementation of the potential of these drugs.

The purpose — to study the effect of the combined use of chondroitin sulfate and the Revisk synovial fluid prosthesis on reducing the severity of pain and improving functionality in patients with knee osteoarthritis.

Material and methods. 60 patients with stage I–II gonarthrosis according to Kellgren-Lawrence, with intensity of pain according to VAS ≥ 50 mm, and with algofunctional Lequesne index ≥ 5 points were divided into three comparable groups of 20 people. All patients had no contraindications for intramuscular injection of chondroitin sulfate and intraarticular injection of hyaluronic acids, there were no anamnestic indications of their intolerance. In the comparison groups, patients received monotherapy with chondroitin sulfate intramuscularly (group 1) and hyaluronic acid 2.2% (group 2), in the main group, patients received combined therapy with chondroitin sulfate intramuscularly and Revisk intraarticular hyaluronic acid. The effectiveness of therapy was assessed by the dynamics of pain according to the VAS, the algofunctional index of Lequesne, the WOMAC index, and the EQ-5D questionnaire.

Results. With the combined use of chondroitin sulfate and the Revisk synovial fluid prosthesis, a clinically more significant decrease in pain syndrome and an improvement in functional parameters were revealed than with monotherapy with chondroitin sulfate, and than with a single administration of hyaluronic acid preparations. At the end of the course of therapy, the severity of the pain syndrome decreased by 75.57%.

Conclusions. The data obtained allow the use of both drugs in the complex therapy of knee osteoarthritis in patients with comorbidity. The combined use of chondroitin sulfate and Revisk synovial fluid prosthesis in patients with osteoarthritis of the knee joints reduces the severity of pain, improves functional activity, improves the quality of life of patients.

Key words: osteoarthritis, gonarthrosis, chondroitin sulfate, hyaluronic acid, Revisk.

REFERENCES

1. Novoselov K.A., Kornilov N.N., Kulyaba T.A. Povrezhdeniya i zabolevaniya kolennogo sustava [Injuries and diseases of the knee joint]. Travmatologiya i ortopediya. Saint Petersburg: Gippokrat, 2006. Vol. 3, chapter 5. Pp. 213–438.
2. Martel-Pelletier J., Barr A.J., Cicuttini F.M. et al. Osteoarthritis. Nat Rev Dis Primers, 2016, vol. 2 (16072).
3. Spector T.D., Hart D.J., Byrne J. et al. Definition of osteoarthritis of the knee for epidemiological studies. Ann Rheum Dis, 1993, vol. 52, pp. 790–794.
4. Sun X., Zhen X., Hu X. et al. Osteoarthritis in the Middle-Aged and Elderly in China: Prevalence and Influencing Factors. Int J Environ Res Public Health, 2019, vol. 16, p. 23.
5. Vina E.R., Kwoh C.K. Epidemiology of osteoarthritis: literature update. Curr Opin Rheumatol, 2018, vol. 2, pp. 160–167.
6. Madry H., Kon E., Condello V. et al. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc, 2016, vol. 24, pp. 1753–1762.
7. Shapiro K.I., Moskalev V.P., Savel’ev L.N. Invalidnost’ pri travmakh sustavov u lits v vozraste do 45 let [Disability in joint injuries in persons under the age of 45]. Diagnostika i lechenie povrezhdeniy krupnykh sustavov. Saint Petersburg, 1991. Pp. 5–8.
8. Sadykov R.I., Akhtyamov I.F. Evaluation of the efficacy and safety of therapy with chondroitin sulfate in patients with osteoarthritis of the knee and hip joints. Khirurgiya. Zhurnal im. N.I. Pirogova, 2020, no. 7, pp. 76–81 (in Russ.).
9. Alekseeva L.I., Sharapova E.P. Treatment of chronic pain in the joints and back with combined preparations of chondroitin sulfate and glucosamine hydrochloride. Consilium Medicum, 2016, vol. 18 (2), pp. 60–65.
10. Naumov A.V., Alekseeva L.I. Clinical guidelines internal medicine. Management of patients with osteoarthritis and comorbidity. General medical practice, 2016, p. 56.
11. Zhang W. et al. Osteoarthritis and Cartilage, 2010, vol. 18, pp. 476–499.
12. Singh J.A., Noorbaloochi S., MacDonald R. et al. Chondroitin for osteoarthritis. Cochrane Database of Systematic Reviews. Pub Med, 2015, issue 1, art. no. CD005614.
13. Gupta R.C., Lall R., Srivastava A. et al.Hyaluronic acid: molecular mechanisms and therapeutic trajectory. Front Vet Sci., 2019, vol. 6, p. 192.
14. Garantziotis S., Savani R.C. Hyaluronan biology: a complex balancing act of structure, function, location and context. Matrix Biol, 2019, vol. 78–79, pp. 1–10.
15. Altman R.D., Akermark C., Beaulieu A.D. et al. Efficacy and safety of a single intra-articular injection of non-animal stabilized hyaluronic acid (NASHA) in patients with osteoarthritis of the knee. Osteoarthritis Cartilage, 2004, vol. 12 (8), pp. 642–649.
16. Day R., Brooks P., Conaghan P.G. et al. A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticularhyaluronan in osteoarthritis of the knee. J. Rheumatol, 2004, vol. 31 (4), pp. 775–782.
17. Huang T.L., Chang C.C., Lee C.H. et al. Intra-articular injections of sodium hyaluronate (Hyalgan(R)) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the asian population. BMC Musculoskelet Disord, 2011, vol. 12, pp. 221.
18. Juni P., Reichenbach S., Trelle S. et al. Efficacy and safety of intraarticularhylan or hyaluronic acids for osteoarthritis of the knee: a randomized controlled trial. Arthritis Rheum — 2007, vol. 56 (11), pp. 3610–3619.
19. Karlsson J., Sjogren L.S., Lohmander L.S. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology (Oxford), 2002, vol. 41 (11), pp. 1240–1248.
20. Lee P.B., Kim Y.C., Lim Y.J. et al. Comparison between high and low molecular weight hyaluronates in knee osteoarthritis patients: open-label, randomized, multicentre clinical trial. J Int Med Res, 2006, vol. 34 (1), pp. 77–87.
21. Lundsgaard C., Dufour N., Fallentin E. et al. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial. Scand J Rheumatol, 2008, vol. 37 (2), pp. 142–150.
22. Maheu E., Zaim M., Appelboom T. et al. Comparative efficacy and safety of two different molecular weight (MW) hyaluronans F60027 and Hylan G-F20 in symptomatic osteoarthritis of the knee (KOA). Results of a non inferiority, prospective, randomized, controlled trial. Clin Exp Rheumatol, 2011, vol. 29 (3), pp. 527–535.
23. Puhl W., Bernau A., Greiling H. et al. Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthritis Cartilage, 1993, vol. 1 (4), pp. 233–241.
24. Raman R., Dutta A., Day N. et al. Efficacy of Hylan G-F 20 and Sodium Hyaluronate in the treatment of osteoarthritis of the knee — a prospective randomized clinical trial. Knee, 2008, vol. 15 (4), pp. 318–324.
25. Petukhov A.I., Kornilov N.N., Kulyaba T.A. Injectable preparations of hyaluronic acid for the treatment of gonarthrosis from the standpoint of evidence-based medicine. Nauchno-prakticheskaya revmatologiya, 2018, vol. 56 (2), pp. 239–248 (in Russ.).
26. Obshcherossiyskaya obshchestvennaya organizatsiya Assotsiatsiya travmatologov-ortopedov Rossii (ATOR), Obshcherossiyskaya obshchestvennaya organizatsiya Assotsiatsiya revmatologov Rossii (ARR). Klinicheskite rekomendatsii. Gonartroz [All-Russian public organization Association of Traumatologists and Orthopedists of Russia (ATOR), All-Russian public organization Association of Russian Rheumatologists (ARR). clinical guidelines. Gonarthrosis], 2021. P. 32.
27. Badokin V.V. Preparations of chondroitin sulfate in the treatment of osteoarthritis. RMZh, 2009, vol. 21, p. 1461 (in Russ.).
28. Petrella R.J., Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J. Rheumatol, 2006, vol. 33 (5), pp. 951–956.
29. Ezhov I.Yu., Boyarshinov A.A., Glushkov A.E. Combined use of chondroitin sulfate and hyaluronic acid for the treatment of arthrosis. Terapiya, 2019, no. 2, pp. 75–82 (in Russ.).