[The clinical status and treatment options for osteoarthritis in patients with frailty]

[Chondroitin sulfate role in the complex rehabilitation of elderly people with chronic pain syndrome]

The article presents the data of the latest domestic and foreign original studies, the results of a number of meta-analyses, conclusions of randomized clinical trials (RCTs), and other scientific studies that prove the effectiveness and necessity of mandatory inclusion in the treatment of chronic pain syndrome of the stage of non-invasive non-pharmacological therapy. One of the promising areas of pharmacotherapy for degenerative-dystrophic joint lesions is the use of chondroprotectors (CP), in particular chondroitin sulfate (CS). According to new Clinical Recommendations of Ministry Health (MH) of the Russian Federation (RF) «Chronic pain in patients of elderly and senile age» (2020), according to which the purpose of CS is recommended for patients older than 60 years with joint pain and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or senile asthenia for the purpose of pain relief and the prevention of exacerbations of pain. A high level of reliability and persuasiveness of the recommendations was noted (1A) of CS use. Most of the CS is available in the form of forms for oral use, the bioavailability of which, according to clinical studies, is 13-38% due to the destruction of the CS molecules in the gastrointestinal tract. Intramuscular (i/m) administration of the drug can increase the bioavailability of CS, which can not only increase the effectiveness of therapy, but also lead to a more rapid development of the symptomatic effect. In Russia available parenteral forms of CS (Chondroguard) pharmaceutical quality, efficacy has been proven in randomized clinical trial (RCT) MH RF. To relieve pain in the joints, it is recommended to use parenteral forms of CS (Chondroguard) at a dose of 100-200 mg per day, every other day, the total duration of the course of treatment is 25-30 injections.

[Antiresorptive activity of pharmacological chondroitin sulfate in the older age group]

The prevalence of osteoarthritis (OA) increases in proportion to age, so in the population of people over 65 years of age. The pathogenesis of OA is based on inflammation of the cartilage tissue of the joint, which leads to damage to the cartilage, activation of signaling pathways and increased levels of cytokines.

AIM

To study the literature data on bone and cartilage remodeling with the development of resorptive processes and discuss possible algorithms and recommendations for the management of patients with OA on the background of chondroprotective therapy.

MATERIALS AND METHODS

A comprehensive analysis of data presented in open sources, published and available on such resources as PubMed, EMBASE, Cochrane, and Library.

RESULTS

According to the available recommendations and the opinion of experts, among the methods of OA therapy, drugs containing pharmaceutical chondroitin sulfate are currently being discussed, which in a number of studies has demonstrated high antiresorptive effectiveness.

CONCLUSION

The use of drugs based on pharmaceutical chondroitin sulfate (Chondroguard) contributes not only to the reduction of pain in OA, but also has a positive effect on the processes of inflammation, including those associated with age-related changes in the body.

Anti-inflammatory and anti-aging effects of chondroitin sulfate

Biological ageing is a process that changes living systems over time, causing impairments in their structure and function. Studying the individual biomarkers of ageing is regarded as the most plausible current theory of age-related inflammatory processes (inflammageing). According to this theory, slightly pronounced chronic aseptic inflammation develops during ageing, which is the basis for the pathogenesis of age-related syndromes and diseases. A key role in implementing different cellular interactions and in regulating the type of an inflammatory response is assigned to the cytokine status (nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and IL-6) in an elderly patient with age-related diseases, such as osteoarthritis (OA) and diabetes mellitus (DM), developed in the altered background. Anti-inflammatory drugs include chondroitin sulfate (CS) that, in addition to directly affecting the severity of pain syndrome in OA, also has a modulating effect on the level of systemic inflammation. Pharmaceutical CS plays an important role in tissue remodeling, cell proliferation, migration, and differentiation, apoptosis, activation and deactivation of chemokines and cytokines, by increasing the synthesis of hyaluronic acid and proteoglycans, by suppressing the synthesis of prostaglandin E2 (PGE2), IL-1, and IL-6 and the expression of cytokines and NF-κB. CS belongs to anti-aging drugs.