[Teraflex in the treatment of osteoarthritis of the knee, and osteoarthritis of the spine (the results of a clinical trial)]

Osteoarthritis (OA) - a chronic, progressive disease, a characteristic feature of which is the presence of destructive changes of the articular cartilage and subchondral bone with the development of marginal osteophytes. Stifle in OA are affected most frequently (about 10% of the population older than 55 years), with 25% of them expressed lesions functional activity [1]. The risk of disability in patients with knee OA is comparable with the group of elderly patients suffering from cardiovascular diseases, and higher than in other diseases in these patients. High disability patients with OA of the knee is the reason that the annual incidence artroplasticheskih transactions among patients older than 65 years in Europe, an average of 0.5-0.7 per 1000 population [2]. Among the most important risk factors for OA of the greatest importance is attached to the common constitutional (age, sex, overweight, hereditary predisposition, developmental abnormalities of the musculoskeletal system, dishormonal disorders, and other diseases of the internal organs) and local adverse mechanical factors (injuries, occupational and household factors , posture, etc.). The pathogenesis of OA is an imbalance between the anabolic and catabolic processes, primarily in the hyaline cartilage and subchondral bone, which is induced and maintained by a variety of factors. It should be emphasized that the disease process in OA captures all the tissues of the joint, including synovial membrane, joint capsule, intraarticular ligaments and periarticular muscles. The main complaint with which patients with OA seek medical attention, is a pain in the joint and a gradual decline in function. The cause of pain is the inflammation of the synovial membrane of the joint (reactive synovitis) or periarticular tissues (muscles, tendons, bags), the excess pressure in the subchondral bone, degenerative changes in the near-or intra-articular ligaments, irritation of surrounding tissue is formed osteophytes, and others. With the progression of the disease is often detected reflex spasm of muscles, accompanied by the formation of tendon-muscle contractures, which is one of the reasons for strengthening the already existing pain. Physical disability due to pain and limitation of joint functional activity, reduces the quality of life and increased risk of comorbidity and mortality. Diagnosis of OA is based on clinical symptoms and instrumental studies (Table. 1). Modern therapy OA has two main objectives - reducing the pathological symptoms and prevent further progression of the degenerative processes in the articular cartilage and subchondral bone [2]. However, the effectiveness and appropriateness of different methods of treatment of knee OA is very varied, which led to a revision of the international recommendations for the treatment of the disease (data from the special Commission of the Standing Committee of the European Antirheumatic League (EULAR) for international clinical, including therapeutic, research ( ESSISIT 2003) [4]. According to these guidelines in the treatment of patients with knee OA should be considered: • presence of risk factors (obesity, adverse mechanical factors, increased physical activity); • presence of common risk factors (age, comorbidities, taking of drugs of different groups); • the severity of pain and functional impairment of the joints; • any signs of inflammation, including synovitis; • location and extent of structural damage. The final list of 10 recommendations of the special commission EULAR on treatment of knee OA based on data from evidence-based medicine and expert opinion, points to the need for the treatment of diseases of symptomatic slow-acting drugs (glucosamine sulfate, chondroitin sulfate, unsaponifiable compounds of avocado / soybean, and diacerein hyaluronic acid), having the ability to modify the structure of the cartilage [4]. According to mnogochislennyhissledovany chondroitin and glucosamine have a moderate or significant impact on pain and functional mobility of OA compared to placebo; these drugs are safe and are characterized by a minimum of side effects [3,5,7,8,10]. According to a meta-analysis including all available published studies on the subject, the severity of the therapeutic effect of chondroitin sulfate and glucosamine sulfate was 0.78 and 0.44, respectively [4]. The important thing was that the three-year use of glucosamine sulfate in patients with mild to moderate OA had significantly compared with placebo slowing reducing the height of the joint space, reducing pain and improving the functional activity of the joints [9].