[Relationship between hypercholesterolemia and osteoarthritis (preliminary results)].

AIM: To evaluate the relationship of hypercholesterolemia (HCE) with clinical, instrumental, and laboratory parameters in osteoarthritis (OA) in a multicenter, cross-sectional study. MATERIALS AND METHODS: The study included 183 patients aged 40-75 years, with a confirmed diagnosis of stage I-III OA (ACR) of the knee joints, who signed an informed consent. The mean age was 55.6±10.7 years (40 to 75), body mass index was 29.3±6.3 kg/m2, and disease duration was 5 [1; 10] years. For each patient, a case record form was filled out, including anthropometric indicators, medical history, clinical examination data, an assessment of knee joint pain according to VAS, WOMAC, KOOS and comorbidities. All patients underwent standard radiography and ultrasound examination of the knee joints and laboratory tests. RESULTS: HCE was detected in 59% of patients. Depending on its presence or absence, patients were divided into two groups. Patients were comparable in body mass index, waist and hip measurement, and disease duration but differed significantly in age. Individuals with elevated total cholesterol levels had higher VAS pain scores, total WOMAC and its components, an overall assessment of the patient's health, a worse KOOS index, and ultrasound findings (reduced cartilage tissue). HCE patients showed high levels of cholesterol, low-density lipoproteins, triglycerides, STX-II, and COMP (p<0.05). However, after stratification by age, many initial intergroup differences became insignificant, and differences in the WOMAC pain score persisted. CONCLUSION: The results of the study confirmed the high prevalence of HCE in OA patients (59%). Patients with OA and increased total cholesterol have more intense pain in the knee joints.

[Efficacy and safety of undenatured type II collagen in patients with knee osteoarthritis: a multicenter, prospective, double-blind, placebo-controlled, randomized trial].

BACKGROUND: Non-pharmacological treatments based on collagen as a dietary supplement are emerging as a new area of interest to support preventive or therapeutic effects in patients with osteoarthritis (OA). AIM: In a multicenter, prospective, double-blind, placebo-controlled, randomized study, to evaluate the effectiveness and safety of the use of the Artneo complex containing undenatured chicken collagen type II in patients with OA of the knee joints. MATERIALS AND METHODS: The study enrolled 212 outpatients from 12 centers in the Russian Federation with knee OA, stages II and III according to the Kellgren-Lawrence classification. The participants included 171 women (80.7%) and 41 men (19.3%), with an average age of 60.2±9.0 years (range: 40 to 75 years). The study population was randomly allocated in equal proportions into two groups using an interactive web response system (IWRS). Group 1 (Artneo) consisted of 106 patients who took one capsule of the drug once daily for 180 days. Group 2 (Placebo) also had 106 patients, with the dosage form and regimen identical to Group 1. During the treatment period, the following outcomes were assessed: WOMAC index, KOOS, pain according to VAS, quality of life using the EQ-5D questionnaire, and the need for NSAIDs. All patients underwent a clinical blood test, general urine analysis, biochemical blood test, and ultrasound examination of the affected knee joint. RESULTS: In a prospective, double-blind, placebo-controlled, randomized study, it was demonstrated that the Artneo combination, containing undenatured chicken collagen type II, has a positive effect on all clinical manifestations of OA: it effectively reduces pain, stiffness, and improves the functional state of joints and quality of life. It has a good safety profile and is superior to placebo in all parameters studied. CONCLUSION: The results of the study confirm the good effectiveness and safety of the Artneo combination in patients with OA of the knee joints.

[The efficacy and safety of intra-articular application of a combination of sodium hyaluronate and chondroitin sulfate for osteoarthritis of the knee: a multicenter prospective study].

in 3 mL on patients with knee osteoarthritis (OA) in a multicenter prospective study. MATERIALS AND METHODS: 79 outpatients (predominantly females 81.0%) from 5 RF constituent territories with primary tibiofemoral KellgrenLawrence score grade II or III knee OA, 40 mm pain intensity during walking on visual analogue scale (VAS), requiring NSAIDs intake (for at least 30 days during 3 months prior to enrollment) were included into the study after signing the informed consent form. Mean age was 60.38.7 years, mean BMI 29.24.7 kg/m2, disease duration 6 (310) years. Grade II OA was documented in 68.4% of patients, Grade III in 31.6%. The study lasted for 6 months. Efficacy and safety evaluations were made based on VAS pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [WOMAC pain (0500), WOMAC function (01700), WOMAC stiffness (0200)], VAS patients health status, EQ-5D-based assessment of patients quality of life, global physicians and patients efficacy assessment, and daily NSAIDs requirements. RESULTS: Obtained results demonstrate statistically significant VAS pain reduction during walking already in 1 week after intra-articular injection of the combination [respectively, 62 (5572) and 41 (3251) mm, р0.0001]. Moreover, pain continued to subside during all 3 months of follow up [in 1 month 28 (2042), in 3 month 22 (1437) mm]. A significant pan reduction achieved at Mo 3 persisted until Mo 6 20 (1442) mm, without documented pain increase. Similar trends were observed with total WOMAC score [1125 (8991540) at baseline, and 552 (309837) mm by the end of the study, p0.0001], and all WOMAC sub-scores [268 (189312) baseline WOMAC pain, 91 (48171) mm by the end of the study p0.0001; stiffness 101 (59130) and 40 (2061) mm, p0.0001; function 802 (6471095) and 402 (191638) mm, p0.0001, respectively]. Median time to the onset of therapeutic effect was 7 (518) days. Statistically significant improvement of patients quality of life by EQ-5D and general health status was observed during all follow up period [respectively, 0.52 (-0.020.59) and 0.69 (0.590.80), р0.0001; 48 (3060) and 72 (6080) mm, р0.0001]. One injection of the drug resulted in dose reduction or discontinuation of NSAIDs therapy: at baseline 76 patients (96.2%) were taking NSAIDs, in one week 31 (39.2%) patients discontinued NSAIDs, in 1 month 72.2%, in 3 months 73.4%, and by the end of the study at Mo 6 54.4% were not taking NSAIDs. These data were consistent with physicians and patients global assessment of the efficacy of treatment, who stated significant improvement and improvement in the majority of cases, with only few no effect or worsening cases documented in analyzed population. Adverse events, such as worsening of pain and/or swelling of the joint, were documented in 8 patients (10.1%); they resolved spontaneously or following NSAIDs intake. CONCLUSION: These results suggest that intra-articular injections of hyaluronic acid plus chondroitin sulfate in patients with knee OA are efficient and safe. A single injection of the drug resulted in statistically significant reduction of pain and stiffness, reduction in NSAIDs intake, as well as improvement in patients quality of life and function.

[The сhanges of bone mineral density on the risk of progression of osteoarthritis of the knee].

AIM: To find the relationship between bone mineral density (BMD) and risk of knee OA progression in a 5-year prospective study. MATERIALS AND METHODS: 110 females with knee OA were examined twice with 5-year interval. Examination included filling questionnaires, VAS pain assessment, plain knee radiography and axial skeleton densitometry. I stage knee OA was established in 33 (30%) patients, II stage - in 46 (41.8%), III stage - in 26 (23.6%), and IV - in 5 (4.5%). Normal lumbar vertebrae densitometry BMD values were found in 45 patients (40.9%), osteopenia - corresponding BMD values - in 33 (30.0%), and osteoporosis - in 32 (29.1%). Normal femoral neck BMD values were identified in 60 (54.5%) patients, osteopenia - level BMD - in 48 (43.7%), osteoporosis - in 2 (1.8%). In all premenopausal patients (n=15) axial skeleton BMD values were normal. RESULTS: In 5-year interval radiographic progression was established in 40 patients (Group 2), while in 70 (Group 1) patients no progression occurred. Both groups were comparable in terms of age and disease duration, although, more patients from Group 2 tended to have normal baseline densitometry BMD values - both in lumbar vertebrae and femoral neck: 47.5% vs 37.1%, and 62.5% vs 44.3% as compared to Group 1 patients. Patients from Group 1 more often had BMD values corresponding to osteoporosis and osteopenia: 32.9% vs 22.5%, and 55.7% vs 37.5%, respectively, as compared to Group 2 patients, although not achieving statistical significance. These differences were still identifiable after 5-year interval. Absolute BMD values at the second examination in 5 years were indicative of statistically significant increase in femoral neck and total hip BMD in Group 2 patients with knee OA progression: 0.79±0.11 vs 0.73±0.16, р.

[Use of ARTRA MSM FORTE in patients with knee osteoarthritis: Results of a randomized open-label comparative study of the efficacy and tolerability of the drug].

AIM: To study the clinical efficacy and safety of the combined medication ARTRA MSM FORTE (400 mg chondroitin sulfate, 500 mg glucosamine hydrochloride, 300 mg methylsulfonylmethane (MSM), and 10 mg sodium hyaluronate calculated with reference to hyaluronic acid) in patients with knee osteoarthritis (OA). SUBJECTS AND METHODS: The study enrolled 100 patients with Kellgren-Lawrence grades 2-3 knee OA with obvious pain syndrome (pain intensity scores on a visual analog scale (VAS)) equal or greater than 40 mm during walking. The patients were examined monthly; changes in WOMAC index scores, Get-Up and Go test results, the efficiency of therapy in the opinion of a physician and a patient, and quality of life according to the EQ-5D questionnaire were estimated. They were randomized into 2 groups: 1) 50 patients took ARTRA MSM as 2 tablets daily for one month, then 1 tablet daily; 2) 50 received ARTRA in accordance with the same scheme. Clinical examination was performed before and at 30, 60, 90 and 120 days of the study. RESULTS: All the 100 patients completed treatment. Analysis of the results showed a significant decrease in pain on VAS in both groups. Reduced pain intensity was observed by the end of the first month of therapy and remained throughout the follow-up. Both medications diminished stiffness just after a month of therapy. They alleviated joint function and reduced total WOMAC scores at Visit 2. Analysis of Get-Up and Go test results indicated significantly less spent time in both groups; however, these differences reached the statistical significance in the ARTRA MSM group just at Visit 2 and in the ARTRA group only at Visit 3. The effect ARTRA MSM occurred more rapidly. This was confirmed by the patient and physician evaluations of the efficiency of treatment, which indicated that its positive effect occurred more rapidly in the ARTRA MSM group (p=0.02). Estimation of EQ-5D scores also showed positive results: there was a significant improvement of these indicators in the two compared groups at Visit 3. Both medications were very well tolerated and caused no adverse reactions; therapy was not discontinued. CONCLUSION: ARTRA MSM is rapider in its effect: a significant improvement in Get-Up and Go test results and patient and physician evaluations of the efficiency of treatment. Additional interviews of the patients taking ARTRA MSM demonstrated that 36 (72%) of them reported a prompter pain relief than the ARTRA-treated patients. ARTRA MSM may be recommended for the treatment of OA in clinical practice.

[Association between bone mineral density and erosive and destructive changes in patients with rheumatoid arthritis: preliminary results].

AIM: To obtain information on and to study an association between the erosive and destructive changes in the hand and foot joints, bone mineral density (BMD) in different parts of the skeleton and the X-ray alterations in the thoracic and lumbar vertebrae of patients with rheumatoid arthritis (RA). SUBJECTS AND METHODS: The investigation enrolled 66 women with a valid RA diagnosis, whose mean age was 51.6 +/- 9.6 years and the disease duration was 13.2 +/- 9.1 years. All the patients underwent clinical, laboratory, and X-ray studies assessing the progression of joint changes by the Sharp/van der Heijde method and estimating the vertebral body deformity index by the Genant technique, and BMD in 3 skeletal regions by dual-energy X-ray absorptiometry employing a Holovic Discovery A device. RESULTS: With X-ray higher-stage RA and higher Sharp total scores, regardless of age, there was a decrease in BMD in all skeletal areas and an increase in the number of patients with deformities of vertebrae and osteoporosis (OP) in at least one of the analyzed skeletal part. Thus, OP was found in 29% of the patients with Stages I and II RA and in 65% of those with Stages IV; deformities of vertebrae were in 12 and 22%, respectively. Comparative analysis of BMD and erosive and destructive changes in the patient groups different in age at onset of the disease has established that its young onset (from 16 to 30 years) and long duration have a negative effect on bone status. Femoral neck BMD in these patients is significantly lower than that in patients who were ill at older age (31-50 or over 50 years) (0.661 +/- 0.080, 0.739 +/- 0.111, and 0.713 +/- 0.120 g/cm2, respectively) and the Sharp total score was higher (181.1 +/- 91.3, 100.5 +/- 71.5 and 103.9 +/- 74.5, respectively). The patients' mean age in these groups at the study inclusion was 46.7 +/- 12.1, 51.9 +/- 6.7, and 60.3 +/- 3.3 years, respectively. CONCLUSION: With the longer disease duration, regardless of the age of patients with RA, there are increases in both Sharp total scores, X-ray RA stage, and the number of patients with OP, deformities of thoracic and lumbar vertebrae (however, there is no evidence of significant differences), BMD decrease in all skeletal parts.

[Evaluation of the efficacy and tolerance of ibandronic acid in patients with osteoarthrosis in the knee joints concurrent with osteoporosis: a pilot study].

AIM: To evaluate the efficacy and tolerance of ibandronic acid (bonviva) in patients with osteoporosis (OP) concurrent with osteoarthrosis (OA) in the knee joints (KJ). SUBJECTS AND METHODS: Twenty female outpatients aged 56 to 77 years with postmonopausal OP and primary KJ OA were examined. All the patients took bonviva in a dose of 150 mg monthly during a year. RESULTS: During the treatment, the patients showed a significant reduction in the values of all components of the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) (pain intensity from 51.7 +/- 11.6 to 34.6 +/- 20.7 mm, stiffness from 96.0 +/- 55.6 to 78.5 +/- 46.6 mm, and functional failure from 783.6 +/- 333.2 to 657.8 +/- 360.9 mm according to a visual analogue scale), the Oswestry disability index, as well as in the concentration of markers for bone resorption and cartilage degradation. The need for nonsteroidal anti-inflammatory drugs was stated to decrease. CONCLUSION: Bonviva therapy results in a significant reduction in pain, KJ stiffness, and locomotor functional failure in patients with gonoarthrosis.