chondroitin-sulfates and Osteoarthritis--Hip

Osteoarthritis, a common joint disorder, is one of the leading causes of disability. Chondroitin has emerged as a new treatment. Previous meta-analyses have shown contradictory results on the efficacy of chondroitin. This, in addition to the publication of more trials, necessitates a systematic review.. To evaluate the benefit and harm of oral chondroitin for treating osteoarthritis compared with placebo or a comparator oral medication including, but not limited to, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, opioids, and glucosamine or other "herbal" medications.. We searched seven databases up to November 2013, including the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, CINAHL, EMBASE, Science Citation Index (Web of Science) and Current Controlled Trials. We searched the US Food and Drug Administration (FDA) and European Medicines Agency (EMEA) websites for adverse effects. Trial registers were not searched.. All randomized or quasi-randomized clinical trials lasting longer than two weeks, studying adults with osteoarthritis in any joint, and comparing chondroitin with placebo, an active control such as NSAIDs, or other "herbal" supplements such as glucosamine.. Two review authors independently performed all title assessments, data extractions, and risk of bias assessments.. Forty-three randomized controlled trials including 4,962 participants treated with chondroitin and 4,148 participants given placebo or another control were included. The majority of trials were in knee OA, with few in hip and hand OA. Trial duration varied from 1 month to 3 years. Participants treated with chondroitin achieved statistically significantly and clinically meaningful better pain scores (0-100) in studies less than 6 months than those given placebo with an absolute risk difference of 10% lower (95% confidence interval (CI), 15% to 6% lower; number needed to treat (NNT) = 5 (95% CI, 3 to 8; n = 8 trials) (level of evidence, low; risk of bias, high); but there was high heterogeneity between the trials (T(2) = 0.07; I(2) = 70%, which was not easily explained by differences in risk of bias or study sample size). In studies longer than 6 months, the absolute risk difference for pain was 9% lower (95% CI 18% lower to 0%); n = 6 trials; T(2) = 0.18; I(2) = 83% ), again with low level of evidence.For the Western Ontario and McMaster Universities Osteoarthritis Index Minimal Clinically Important Improvement (WOMAC MCII Pain subscale) outcome, a reduction in knee pain by 20% was achieved by 53/100 in the chondroitin group versus 47/100 in the placebo group, an absolute risk difference of 6% (95% CI 1% to 11%), (RR 1.12, 95% CI 1.01 to 1.24; T(2) = 0.00; I(2) = 0%) (n = 2 trials, 1253 participants; level of evidence, high; risk of bias, low).Differences in Lequesne's index (composite of pain,function and disability) statistically significantly favoured chondroitin as compared with placebo in studies under six months, with an absolute risk difference of 8% lower (95% CI 12% to 5% lower; T(2)= 0.78; n = 7 trials) (level of evidence, moderate; risk of bias, unclear), also clinically meaningful. Loss of minimum joint space width in the chondroitin group was statistically significantly less than in the placebo group, with a relative risk difference of 4.7% less (95% CI 1.6% to 7.8% less; n = 2 trials) (level of evidence, high; risk of bias, low). Chondroitin was associated with statistically significantly lower odds of serious adverse events compared with placebo with Peto odds ratio of 0.40 (95% CI 0.19 to 0.82; n = 6 trials) (level of evidence, moderate). Chondroitin did not result in statistically significant numbers of adverse events or withdrawals due to adverse events compared with placebo or another drug. Adverse events were reported in a limited fashi. A review of randomized trials of mostly low quality reveals that chondroitin (alone or in combination with glucosamine) was better than placebo in improving pain in participants with osteoarthritis in short-term studies. The benefit was small to moderate with an 8 point greater improvement in pain (range 0 to 100) and a 2 point greater improvement in Lequesne's index (range 0 to 24), both seeming clinically meaningful. These differences persisted in some sensitivity analyses and not others. Chondroitin had a lower risk of serious adverse events compared with control. More high-quality studies are needed to explore the role of chondroitin in the treatment of osteoarthritis. The combination of some efficacy and low risk associated with chondroitin may explain its popularity among patients as an over-the-counter supplement.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Glucosamine; Hand; Humans; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Measurement; Randomized Controlled Trials as Topic

Osteoarthritis (OA) is a common, painful, and debilitating condition that affects approximately 46.4 million individuals in the United States. By 2012, this number is expected to increase to 60 million. In addition, it is the leading cause of activity limitation in adults and represents a widely acknowledged economic burden. Although the ultimate goal is to slow or prevent OA progression, at present, medical management of OA is aimed primarily at controlling symptoms of pain and stiffness and maintaining joint mobility and quality of life. Because of the lack or perceived lack of response to many conventional therapies for OA as well as concerns regarding the long-term administration of drugs (eg, nonsteroidal anti-inflammatory drugs), oral joint health supplements (OJHSs) have become increasingly popular among patients with OA. This article briefly reviews pertinent molecular mechanisms involved in the development of OA and summarizes available in vitro and in vivo evidence supporting the use of avocado and soybean unsaponifiables (ASU) either alone or in combination with glucosamine and chondroitin sulfate in patients with OA. Basic scientific research studies and a systematic review and meta-analysis of the available high-quality randomized clinical trials indicate that 300 mg of ASU per day (with or without glucosamine and chondroitin sulfate) appears to be beneficial for patients with hip or knee OA. There is also some evidence that ASU or ASU/glucosamine/chondroitin sulfate combination products could be used prophylactically in even the earliest stages of OA. Considering concerns regarding inferior-quality OJHSs, consumers and physicians are encouraged to take an evidence-based approach when evaluating OJHSs to identify and recommend safe and effective products that meet label claims when tested independently, and are of the highest quality.

Topics: Chondroitin Sulfates; Dietary Supplements; Glycine max; Humans; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Persea; Quality of Life

Osteoarthritis (OA) is a common joint disorder and a major socio-economic burden. Chondroitin sulfate (CS), which has chondroprotective properties, is a promising candidate for the therapeutic treatment of OA. Here, we summarize current knowledge as well as future trends of CS for the treatment of hip and knee OA.. We retrospectively reviewed pharmacokinetics, pharmacodynamics, clinical efficacy, safety and tolerability of CS for the treatment of OA.. The safety and tolerability of CS are confirmed. CS is effective, at least in part, for the treatment of OA, and its therapeutic benefits occur through three main mechanisms: 1) stimulation of extracellular matrix production by chondrocytes; 2) suppression of inflammatory mediators; and 3) inhibition of cartilage degeneration.. CS is a safe and tolerable therapeutic agent for the management of OA. Its effects include benefits that are not achieved by current medicines and include chondroprotection and the prevention of joint space narrowing. Such positive effects of CS represent a breakthrough in the treatment of hip and knee OA.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondrocytes; Chondroitin Sulfates; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee

Previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis. However, recent large-scale trials did not find evidence of an effect.. To determine the effects of chondroitin on pain in patients with osteoarthritis.. The authors searched the Cochrane Central Register of Controlled Trials (1970 to 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), CINAHL (1970 to 2006), and conference proceedings; checked reference lists; and contacted authors. The last update of searches was performed on 30 November 2006.. Studies were included if they were randomized or quasi-randomized, controlled trials that compared chondroitin with placebo or with no treatment in patients with osteoarthritis of the knee or hip. There were no language restrictions.. The authors extracted data in duplicate. Effect sizes were calculated from the differences in means of pain-related outcomes between treatment and control groups at the end of the trial, divided by the pooled SD. Trials were combined by using random-effects meta-analysis.. 20 trials (3846 patients) contributed to the meta-analysis, which revealed a high degree of heterogeneity among the trials (I2 = 92%). Small trials, trials with unclear concealment of allocation, and trials that were not analyzed according to the intention-to-treat principle showed larger effects in favor of chondroitin than did the remaining trials. When the authors restricted the analysis to the 3 trials with large sample sizes and an intention-to-treat analysis, 40% of patients were included. This resulted in an effect size of -0.03 (95% CI, -0.13 to 0.07; I2 = 0%) and corresponded to a difference of 0.6 mm on a 10-cm visual analogue scale. A meta-analysis of 12 trials showed a pooled relative risk of 0.99 (CI, 0.76 to 1.31) for any adverse event.. For 9 trials, the authors had to use approximations to calculate effect sizes. Trial quality was generally low, heterogeneity among the trials made initial interpretation of results difficult, and exploring sources of heterogeneity in meta-regression and stratified analyses may be unreliable.. Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.

Topics: Aged; Chondroitin Sulfates; Female; Hip Joint; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain; Radiography; Randomized Controlled Trials as Topic

Osteoarthritis (OA), the most common form of arthritis, is a public health problem throughout the world. Several entities have been carefully investigated for the symptomatic and structural management of OA. This review evaluates published studies of the effect of glucosamine salts and chondroitin sulfate preparations on the progression of knee or hip OA. Despite multiple double-blind, controlled clinical trials of the use of glucosamine and chondroitin sulfate in OA, controversy regarding the efficacy of these agents with respect to symptomatic improvement remains. Several potential confounders, including placebo response, use of prescription medicines versus over-the-counter pills or food supplements, or use of glucosamine sulfate versus glucosamine hydrochloride, may have relevance when attempting to interpret the seemingly contradictory results of different clinical trials. The National Institutes of Health-sponsored GAIT (Glucosamine/chondroitin Arthritis Intervention Trial) compared placebo, glucosamine hydrochloride, chondroitin sulfate, a combination of glucosamine and chondroitin sulfate and celecoxib in a parallel, blinded 6-month multicentre study of patients with knee OA. This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain. For decades, the traditional pharmacological management of OA has been mainly symptomatic. However, in recent years, several randomised controlled studies have assessed the structure-modifying effect of glucosamine sulfate and chondroitin sulfate using plain radiography to measure joint space narrowing over years. There is some evidence to suggest a structure-modifying effect of glucosamine sulfate and chondroitin sulfate. On the basis of the results of recent randomised controlled trials and meta-analyses, we can conclude that glucosamine sulfate (but not glucosamine hydrochloride) and chondroitin sulfate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulfate and chondroitin sulfate may interfere with progression of OA.

Topics: Chondroitin Sulfates; Drug Therapy, Combination; Glucosamine; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Randomized Controlled Trials as Topic; Treatment Outcome

Topics: Arthralgia; Chondroitin Sulfates; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Randomized Controlled Trials as Topic

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chondroitin Sulfates; Drug Therapy, Combination; Exercise; Glucosamine; Humans; Injections, Intra-Articular; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Osteotomy; Physical Therapy Modalities

ARTHROSIS TODAY: Representing the most frequent articular pathology, the prevalence of which increases with age, arthrosis associates elements of construction and destruction. It is a disease of the cartilage in which genetic, mircotraumas, cytokines and microcrystals intervene, associated with abnormalities (notably alteration in density) of the sub-chondral bone. From a therapeutic point of view, the surgical, medicinal or non-pharmacological treatments that are currently available are of unconfirmed efficacy for some of them. CLINICAL-RADIOLOGICAL PARAMETERS AND BIOCHEMICAL MARKERS: A comparison of the levels of biochemical markers with radiological progress and the algofunctional indices in patients presenting with gonarthrosis has shown that, although there is no clear parallel, there are however certain correlations. The chondroïtin sulfates ACS4-ACS6 may intervene not only in radiological progression but also in articular metabolism.. Several local and systemic biomechanical factors (notably anklyzing hyperostosis) are significantly related to gonarthrosis, whereas tobacco abuse has a protective role. Compensated soles and internal femorotibial athrosis of the knee A prospective study conducted over 2 years did not show any symptomatic or structural effect of wearing compensated soles in internal gonarthrosis. However the consummation of non-steroid anti-inflammatories was reduced and compliance was improved. Following prosthesis of the hip the quality of life of patients having been operated on was similar to that of the control group. However, in nearly one third of the patients, there was no significant improvement in pain and/or articular function. Old age, severe pre-surgical pain, and concomitant muscle-skeleton affections represent factors that are of poor post-surgery prognosis.

Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Biomarkers; Biomechanical Phenomena; Chondroitin Sulfates; Diagnosis, Differential; Double-Blind Method; Female; Humans; Longitudinal Studies; Male; Middle Aged; Multicenter Studies as Topic; Multivariate Analysis; Odds Ratio; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Prospective Studies; Quality of Life; Randomized Controlled Trials as Topic; Risk Factors; Shoes; Surveys and Questionnaires

In 2000, both the American College of Rheumatology (ACR) and the European League of Associations of Rheumatology (EULAR) published recommendations for the use of pharmacological therapy in the treatment of patients with lower limb osteoarthritis. These recommendations are based on the level of evidence observed in systematic reviews and/or meta-analyses of published randomized controlled trials as well as expert opinion. Acetaminophen (paracetamol) is considered as first-line oral therapy for symptomatic lower limb osteoarthritis with mild to moderate pain because it is more efficacious than placebo and is generally considered to be safe and well tolerated. Data obtained in recent trials and the results of a meta-analysis, however, show that acetaminophen is not as efficacious as non-steroidal anti-inflammatory drugs (NSAIDs) for pain at rest and pain on motion. Furthermore, data from a recent epidemiological study suggest that use of high-dose acetaminophen (>2 g/day) may convey the same magnitude of increased risk for serious upper gastrointestinal adverse events as NSAIDs.NSAIDs have demonstrated efficacy superior to placebo in patients with osteoarthritis. The newer cyclo-oxygenase (COX)-2-specific inhibitors (coxibs) have comparable efficacy to traditional dual inhibitor NSAIDs and have demonstrated a better gastrointestinal safety profile. Thus, for patients who have severe pain and/or signs of inflammation or who have failed to respond to acetaminophen, the use of a coxib should be considered, especially if the patient is at increased risk for serious upper gastrointestinal adverse events from a traditional NSAID.Compounds different from pure analgesics and NSAIDs are also used for the management of patients with osteoarthritis. Recent clinical trials have demonstrated statistically significant efficacy of such compounds (e.g. chondroitin sulphate, diacerhein, glucosamine sulphate) with the following characteristics: (1) the effect size seems to be of slightly lower magnitude than that seen for NSAIDs; (2) the onset of action is delayed for approximately 4 to 6 weeks; and (3) the symptomatic effect is maintained after stopping the treatment for periods of 4 to 8 weeks.The methodology for evaluating the possible structure-modifying effect of drugs has dramatically improved during the past decade. Two agents have demonstrated a beneficial structural effect: glucosamine sulphate in osteoarthritis of the knee, and diacerhein in osteoarthritis of the hi

Topics: Acetaminophen; Anthraquinones; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Chondroitin Sulfates; Glucosamine; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee

What is the level of evidence for current symptomatic agents (SYSADOA) in patients with osteoarthritis? Existing publications which met the inclusion criteria were rated by calculating the effect size of the compounds and applying a quality assessment score of the study methodology. This produced a median effect size for the primary outcome measure, pain, of 1.37 (range 0.37-1.50) for chondroitin-sulphate and 0.57 (range 0.26-1.02) for glucosamine-sulphate in patients with knee osteoarthritis. These effect sizes were strongly diminished when only recent high-quality studies were considered (effect size of pain for chondroitin-sulphate 0.37 and for glucosamine-sulphate 0.26). Effect sizes for functional improvement and overall WOMAC index (pain, stiffness and function) were in the same range for both compounds. So far, and in contrast to recent claims, there is no reliable scientific evidence that these two substances have structure-modifying actions with respect to prohibiting, healing or restoring cartilage lesions. There is only scarce or no scientific evidence for the effects of nutrients in patients with knee, hip or hand osteoarthritis. Several large company-sponsored and independent trials with several of these nutripharmaceuticals are ongoing in Europe and the USA.

Topics: Chondroitin Sulfates; Dietary Supplements; Drug Combinations; Glucosamine; Glycine max; Humans; Meta-Analysis as Topic; Nonprescription Drugs; Osteoarthritis, Hip; Osteoarthritis, Knee; Persea; Plant Extracts; Plants, Medicinal; Trace Elements; Treatment Outcome; Vitamins

Topics: Aged; Analgesics; Chondroitin Sulfates; Collagen; Dietary Supplements; Female; Glucosamine; Humans; Locomotion; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Measurement; Spain; Treatment Outcome

The goal of this study was to evaluate the effectiveness of an oral joint supplement in working dogs with hip osteoarthritis compared with a positive control group (CG). Fifteen animals were divided in treatment group (TG, n = 10) and CG (n = 5). To TG a commercially available joint supplement, containing glucosamine HCl, chondroitin sulphate, and hyaluronic acid was given for 40 days and a 70-day course of a placebo, to be administered as if it was carprofen. The CG received carprofen for 70 days, and a placebo to be administered as the joint supplement. Response to treatment, measured by the canine brief pain inventory (CBPI) and the Hudson visual analog scale, was evaluated before treatment (T0), after 15 days (T1) and 1 (T2), 2 (T3), 3 (T4), 4 (T5), and 5 (T6) months. With CBPI, no differences were found in pain interference score and pain severity score between TG and CG throughout or when comparing results within groups. Individual results were considered successful in a maximal of three dogs of the TG by T3 (30%) and 1 in CG (25%). With Hudson visual analog scale, improvements where registered with individual results, for 40%-50% of the animals in TG and 60%-80% of cases in CG. The oral joint supplement and carprofen produced some improvements in individual scores but where unable to do so when overall results were considered. Each of these options may not be able, by itself, to fully address the demands of a working dog with joint disease and related pain.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Carbazoles; Chondroitin Sulfates; Dietary Supplements; Dog Diseases; Dogs; Glucosamine; Hyaluronic Acid; Osteoarthritis, Hip; Pain

To study chondroitin sulphate (CS) efficacy, tolerance and response duration in elderly patients with osteoarthrosis (OA) with consideration of OA duration and stage.. A total of 97 patients aged 65-85 years with stage II-IV OA by Kellgren-Lawrence received CS treatment. The treatment efficacy was assessed by functional Lecken's index, pain intensity at walking and rest, general functional condition, need in nonsteroid anti-inflammatory (NSAI) drugs. Standardization was achieved with visual analogue scale (VAS).. Positive effects (pain relief, better functional parameters, lower intake of NSAI drugs) were more pronounced and stable in patients with OA stage 1 and 2. In OA of stage 3 and 4, a beneficial effect of a 6-month CS course was unstable. Side effects were at the level of mean statistics.. CS (structum) is recommended for treatment of OA stage 1-4 by Kellgren-Lawrence. Duration of the treatment depends on severity of x-ray symptoms of the disease.

Topics: Aged; Aged, 80 and over; Chondroitin Sulfates; Female; Humans; Male; Osteoarthritis, Hip; Osteoarthritis, Knee; Severity of Illness Index

The efficacy, tolerance and ease of administration of a nutraceutical, carprofen or meloxicam were evaluated in a prospective, double-blind study on 71 dogs with osteoarthritis. The client-owned dogs were randomly assigned to one of the three treatments or to a placebo control group. The influence of osteoarthritis on the dogs' gait was described by comparing the ground reaction forces of the arthritic dogs and 10 normal dogs. Before the treatments began, and 30 and 60 days later, measurements were made of haematological and biochemical variables and of the ground reaction forces of the arthritic limb, and subjective assessments were made by the owners and by the orthopaedic surgeons. Changes in the ground reaction forces were specific to the arthritic joint, and were significantly improved by carprofen and meloxicam but not by the nutraceutical; the values returned to normal only with meloxicam. The orthopaedic surgeons assessed that there had been an improvement with carprofen and meloxicam, but the owners considered that there had been an improvement only with meloxicam. The blood and faecal analyses did not reveal any changes. The treatments were well tolerated, except for a case of hepatopathy in a dog treated with carprofen.

Topics: Administration, Oral; Animals; Anti-Inflammatory Agents, Non-Steroidal; Ascorbic Acid; Carbazoles; Chondroitin Sulfates; Chronic Disease; Dog Diseases; Dogs; Double-Blind Method; Gait; Glucosamine; Lameness, Animal; Manganese Compounds; Meloxicam; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Prospective Studies; Severity of Illness Index; Stifle; Thiazines; Thiazoles; Treatment Outcome

To evaluate duration of a clinical response to the drug structum in patients with osteoarthrosis (OA) of the knee and hip joints as well as structum effects on OA course and that of concomitant diseases.. The duration of a clinical response to structum after the end of the treatment and its effect on OA and concominant diseases course were studied for 12 months in 9 centers participating in the study of the drug efficacy and tolerance in patients with gon- and coxarthrosis in an open multicenter randomized controlled 6-month trial. Out of 555 patients with OA of the knee and hip joints enrolled in the first study, the examination covered 373 patients: 159 patients of the test group treated for 6 months with structum and 214 controls. By basic clinical parameters the groups were similar. Clinical examination was made after structum treatment and 12 months later and included assessment of the number of exacerbations, hospitalizations, outpatient consultations, days of temporary disability for OA, pain in the joints while walking and at rest by the visual scale, Leken's functional index, x-ray pictures of the joints, administration of nonsteroidal anti-inflammatory drugs (NSAID), exacerbations of concomitant diseases (gastrointestinal diseases, arterial hypertension, ischemic heart disease).. An overall functional Leken's index in patients with gon- and coxarthrosis given structum 12 months after the treatment did not reach the initial values as well as pain and daily need in NSAID. Structum effect in patients with knee joint OA persisted for 4.6 months, in hip joint OA--4.1 months; in patients with stage I-II the effect lasted longer than in stage III (5.2 and 4.6 months vs 4.17 and 3.24 months, respectively. Even short-term therapy with structum reduced the number of further exacerbations, hospitalizations and visits to their doctor. 12 months after structum therapy the effect persisted in 40% patients. Frequency of exacerbations of the concomitant diseases was less than in patients on continuous NSAID.. Structum is a highly effective drug against OA as it acts long, reduces frequency of exacerbations, hospitalizations, visits to the doctor, duration of disability, NSAID requirement and improves the course of some concomitant diseases.

Topics: Chondroitin Sulfates; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Severity of Illness Index; Time Factors; Treatment Outcome

We determined the levels of chondroitin sulfate (CS) isomers in the synovial fluid of patients with hip osteoarthritis (OA) to investigate their significance as markers reflecting extracellular matrix metabolism in joint tissues. A cross-sectional study of synovial fluid aspirated from 50 hip joints of 50 patients with OA was performed. Concentrations of chondroitin-4-sulfate (C4S) and chondroitin-6-sulfate (C6S) were determined by high-performance liquid chromatography. Levels of each marker molecule were investigated in relation to age and radiological stage of the disease. In all disease stages, the dominant CS isomer in synovial fluid was C6S. There was a significant negative correlation between levels of C6S and age. A significant inverse correlation was also observed between the ratio of C6S to C4S and age. Results of analysis of covariance in which age was covariate showed that the ratio of C6S to C4S in advanced and terminal stage OA was lower than that in early stage OA. The present results indicate that the ratio of CS isomers in synovial fluid in hip OA varies with the severity of disease. These molecules in synovial fluid may serve as a useful marker reflecting extracellular matrix metabolism in OA.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers; Cartilage, Articular; Chondroitin Sulfates; Chromatography, High Pressure Liquid; Female; Humans; Isomerism; Male; Middle Aged; Osteoarthritis, Hip; Prognosis; Sensitivity and Specificity; Severity of Illness Index; Sex Characteristics; Statistics, Nonparametric; Synovial Fluid

61 patients, suffering from osteoarthritis of the hip, knee and/or finger joints, were included into this open, multicenter, phase IV trial. Patients were treated with chondroitinsulfate (CS) at the recommended dose for 3 months. Concomitant NSAID-therapy, which was necessary for disease control at the beginning of the observation period could be reduced by 72% throughout the 3 months of CS-therapy. The decrease of pain was revealed to be statistically significant; serious side effects were not to be observed during the study. At the beginning of the observation period patients suffered from overall severe pain, and therefore the decrease of pain down to a level, which could not have been achieved by NSAID therapy alone to a greater extent, is of special interest. The results of this trial represent the first office based Austrian data on CS-therapy. In conclusion it could be demonstrated that a significant reduction of the daily NSAID consumption was possible by concomitant CS-therapy, without the risk of deterioration of the patients' symptoms. The 97% compliance does not give evidence for drop-out bias. Moreover, the results of this trial are comparable to other international double-blind, in part placebo-controlled studies, concerning CS-therapy, indicating beneficial results in the treatment of osteoarthritis.

Topics: Administration, Oral; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Finger Joint; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip; Pain Measurement; Treatment Outcome

To evaluate symptom-modifying effects of a two-month parenteral therapy with chondroitin sulfate («Mucosat») in patients with knee and/or hip osteoarthritis (OA) in various combinations of adjuvant therapy.. There were 70 patients with primary and/or post-traumatic unilateral/bilateral knee and/or hip osteoarthritis (Kellgren-Lawrence grade I-II). Pain syndrome severity was assessed as ≥ 50 mm (100-mm VAS), total Leken's index - ≥ 5 points. The main group comprised 40 patients who received Mucosat for 60 days. NSAIDs were additionally prescribed in 9 (22.5%) of these patients. The control group included 30 patients with intra-articular injection of hyaluronic acid. All patients underwent clinical and functional examination (rating scales VAS, Leken's total index, WOMAC index, EQ-5D health questionnaire), laboratory diagnosis (IL-1, IL-6, TNF-α), X-ray examination, assessment of adverse events at 5 visits.. Administration of chondroitin sulfate is associated with reduced local pain syndrome and functional normalization of musculoskeletal system. Prolonged pain-free period with high safety profile due to reduced need for NSAIDs is an advantage of Mucosat therapy. Thus, this drug may be recommended for initial therapy. A combination of chondroitin sulfate with intra-articular injection of hyaluronic acid may be perspective for optimization of therapy and secondary prevention of exacerbations of OA. Further research is required.. Значительное количество исследований достаточно убедительно доказывает эффективность и безопасность монотерапии с применением хондроитина сульфата (ХС), однако варианты адъювантной терапии позволяют расширить возможности амбулаторного лечения ранних стадий остеоартроза.. Оценить симптом-модифицирующие эффекты двухмесячного лечения парентеральной формой ХС (Мукосат) у пациентов с остеоартритом (ОА) коленных и/или тазобедренных суставов при различных сочетаниях адъювантной терапии.. Обследованы 70 пациентов с первичным и/или посттравматическим односторонним/двусторонним ОА коленного и/или тазобедренного суставов I—II рентгенологической стадии по классификации Kellgren и Lawrence. Выраженность болевого синдрома по 100-миллиметровой ВАШ составила 50 мм и выше, по суммарному индексу Лекена — 5 баллов и более. В основную группу вошли 40 пациентов, которые получали Мукосат (60 сут), из них 9 (22,5%) больным дополнительно были назначены НПВП. В группу сравнения включили 30 пациентов, которым назначали внутрисуставное введение гиалуроновой кислоты. Всем пациентам были проведены: клиническо-функциональное обследование по оценочным шкалам (ВАШ, суммарный индекс Лекена, индекс WOMAC, опросник состояния здоровья EQ-5D), лабораторная диагностика (в том числе этапное определение ИЛ-1, ИЛ-6, ФНО-α), рентгенография, оценка нежелательных явлений при 5 визитах.. Применение ХС приводит к уменьшению суставной боли и нормализации функционального состояния опорно-двигательного аппарата. Достоверно более длительный период без боли при высоком профиле безопасности курса за счет снижения потребности в НПВП является преимуществом терапии препаратом «Мукосат» и обосновывает его применение для стартовой терапии. Перспективным для оптимизации терапии и вторичной профилактики обострений ОА может явиться комбинация ХС с внутрисуставным введением гиалуроновой кислоты. Целесообразно продолжение исследований в данном направлении.

Topics: Arthralgia; Chondroitin Sulfates; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis, Hip; Osteoarthritis, Knee; Protective Agents; Treatment Outcome

To relate systemic biochemical markers of joint metabolism to presence, incidence, and progression of early-stage radiographic knee and/or hip osteoarthritis (OA).. The cartilage markers uCTX-II, sCOMP, sPIIANP, and sCS846, bone markers uCTX-I, uNTX-I, sPINP, and sOC, and synovial markers sHA and sPIIINP were assessed by enzyme-linked immunosorbent assay or radioactive immunoassay in baseline samples of CHECK (Cohort Hip and Cohort Knee), a cohort study of early-stage symptomatic knee and/or hip OA. Knee and hip radiographs were obtained at baseline and 5-year follow-up. Presence of OA at baseline was defined as Kellgren and Lawrence (K&L) = 1 (maximum observed). Incidence of OA was defined as K&L = 0 at baseline and K&L ≥ 1 at 5-year follow-up. Progression of OA was defined as K&L = 1 at baseline and K&L ≥ 2 at 5-year follow-up.. Data were available for 801 subjects at baseline and for 723 subjects at both baseline and 5-year follow-up. Multiple cartilage and synovial markers showed positive associations with presence and progression of knee and hip OA and with incidence of hip OA, except for negative associations of uCTX-II and sCOMP with incidence of knee OA. uCTX-II and sCOMP showed multiple interactions with other biomarkers in their associations with knee and hip OA. Bone markers were positively associated with presence of radiographic knee OA, but negatively associated with progression of radiographic hip OA.. Especially metabolism in cartilage and synovial matrix appear to be of relevance in knee and hip OA. The role of bone metabolism appears to differ between knee and hip OA.

Topics: Aged; Biomarkers; Cartilage Oligomeric Matrix Protein; Cartilage, Articular; Chondroitin Sulfates; Cohort Studies; Collagen Type I; Collagen Type II; Disease Progression; Female; Humans; Hyaluronic Acid; Longitudinal Studies; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Osteocalcin; Peptide Fragments; Peptides; Procollagen; Radiography; Synovial Membrane

Topics: Abstracting and Indexing; Chondroitin Sulfates; Conflict of Interest; Drug Evaluation; Editorial Policies; Glucosamine; Humans; Logic; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Peer Review; Periodicals as Topic; Practice Guidelines as Topic; United Kingdom

Dynamics of clinical parameters and quality of life (QL) was evaluated in 281 patients with knee and hip osteoarthrosis (OA) during long-term treatment of different duration. The group was dominated by women (71%) aged 41-65 yr with grade I-III OA according to Kellgren. Patients of groups I and II received only non-steroidal anti-inflammatory drugs (diclofenac, nize), those of groups III-IV the same drugs in combination with structum, chondrolon, and zeel T respectively. Clinical parameters were assessed based on VAS at rest and in motion, Leken's indices, and WOMAC, QL from SF-36 questionnaire. Variable clinical course was recorded in patients treated with non-steroidal drugs alone that caused rapid improvement after the very first treatment sessions followed by deterioration of the patients' condition. Addition of structum resulted in marked optimization of clinical and QL parameters within 3 months after the onset of combined therapy. Similar effect was obtained using chondrolon and zeel T, but 2-3 clinical parameters and 3 QL parameters were not significantly different from the initial ones after 12 and 24 months of therapy. It is concluded that structum produced the best therapeutic effect followed by chondrolon and zeel T. Non-steroidal anti-inflammatory drugs had no beneficial action whatever in patients with OA.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Diclofenac; Female; Humans; Male; Middle Aged; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Quality of Life; Radiography; Surveys and Questionnaires

To evaluate long-term therapeutic effect and safety of structum in patients with manifest coxarthrosis.. Twenty patients with manifest coxarthrosis of degree I-III were given a 6 month structum course. Criteria of efficacy were Leken index, pain in the affected joints, nonsteroid anti-inflammatory drugs requirement, assessment of the efficacy by the patient and the doctor. Structum effects were studied with x-ray examination, CT, INC index. The assessment was made at baseline, after 3 and 6 month therapy and 6.12 and 18 months after the end of the study.. All the patients achieved positive results without side effects on coagulation.. Structum is highly effective in patients with manifest osteoarthrosis of hip joints. Is modifies symptoms, has a potential chondroprotective effect, long-term aftereffect, no significant negative action of coagulation, is well tolerated.

Topics: Adult; Aged; Blood Coagulation; Chondroitin Sulfates; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteoarthritis, Hip; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Chondroitin Sulfates; Humans; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Topics: Chondroitin Sulfates; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain

Biochemical aspects of the etiology of articular cartilage degeneration in osteonecrosis of the femoral head have not been investigated extensively. We analyzed biochemical conditions in the hip joint cavity, regarding articular cartilage turnover in osteonecrosis of the femoral head (ONFH).. Cartilage metabolism markers in synovial fluid were measured. Synovial fluid (SF) samples were collected from 19 ONFH cases and 17 control hips with osteoarthrosis (OA). Concentrations of carboxy-terminal type II procollagen peptide (pCOL-II-C), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured. In addition, concentrations of unsaturated disaccharides of hyaluronic acid (delta di-HA), chondroitin 4-sulfate (delta di-4S), and chondroitin 6-sulfate (delta di-6S) in SF were measured by high performance liquid chromatography.. The mean SF concentration of pCOL-II-C was higher on ONFH than in OA. The mean SF MMP-3 level was higher in ONFH than in OA, while the mean SF TIMP-1 level was the same in the 2 groups. The SF concentration of delta di-HA and the delta di-6S/delta di-4S ratio were higher in ONFH than in OA.. Higher concentrations of cartilage metabolism markers in ONFH compared with OA SF suggest elevated cartilage turnover in the former disease.

Topics: Adolescent; Adult; Aged; Biomarkers; Cartilage; Chondroitin Sulfates; Collagen; Femur Head Necrosis; Humans; Hyaluronic Acid; Matrix Metalloproteinase 3; Middle Aged; Osteoarthritis, Hip; Synovial Fluid; Tissue Inhibitor of Metalloproteinase-1

Heparin-induced thrombocytopenia type II (HIT-II) is a serious complication in heparin treatment. Because of arterial and/or venous thromboembolism, HIT-II quite often takes a life-threatening course. This article describes the clinical course of seven trauma patients, who developed HIT-II during thromboembolism prophylaxis with unfractionated heparin (UFH, Heparin-Natrium-Nattermann, 250,000 I.E., Rhone-Poulenc Rorer GmbH), given subcutaneously. Thromboembolic complications occurred in 5 out of 7 cases (71.4%). One case took a fatal course (14.3%). UFH was replaced by Orgaran when HIT-II was suspected or diagnosed. There were no more complications. Thrombocyte count increased to normal values within 3 to 9 days. The importance of HIT-II in heparin therapy during in- and outpatient therapy is discussed with reference to the current literature.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Chondroitin Sulfates; Dermatan Sulfate; Female; Femoral Neck Fractures; Heparin; Heparitin Sulfate; Hip Fractures; Humans; Male; Middle Aged; Multiple Trauma; Osteoarthritis, Hip; Platelet Count; Postoperative Complications; Thrombocytopenia; Thromboembolism

We studied the early cartilage changes in osteoarthritis, examining the most normal appearing articular cartilage from the hips of 17 patients. Normal appearing cartilage from five patients treated for fractures was used as control material. Two different types of clone were found. The first had increased staining for proteoglycan and was thought to have been engaged in the synthesis of matrix. The other type was associated with a severe deficiency of proteoglycan, matrix streaks and evidence of degradation and phagocytosis of matrix components. Immunohistochemistry demonstrated large amounts of chondroitin 4 and 6 sulphate about the synthetic-type clones, and little or no reactivity about the degenerative clones which lay more superficially and were associated with matrix destruction. Clones appeared to be engaged in either matrix synthesis or its destruction. The disease process of osteoarthritis appeared to begin at the surface of the articular cartilage.

Topics: Aged; Antibodies, Monoclonal; Cartilage, Articular; Chondroitin Sulfates; Clone Cells; Extracellular Matrix; Femur Head; Humans; Immunohistochemistry; Microscopy, Electron; Middle Aged; Osteoarthritis, Hip; Proteoglycans