Background Low efficiency of therapy osteoarthritis (OA) is hypothetically caused by the heterogeneity of this disease. Several studies have demonstrated the analgesic effects of S-adenosil L-methionin (SAMe) in patients with the knee and hip OA comparable with the effect of NSAIDs. Several publications have also shown that SAMe has anti-inflammatory and hypoglycemic properties.
Objectives To assess the influence of SAMe treatment on clinical efficacy parameters, cytokine production and concentrations of c-reactive protein (CRP), glycated hemoglobin (HbA1), erythrocytes sedimentation rate (ESR) in patients with knee OA and diabetes (T2DM) and to compare with SYSADOA treatment.
Methods Ten patients who participated in this study had bilateral knee OA according to the ACR criteria and T2DM diagnosed one year before the start of joint disease. All patients before randomization were divided in two groups: group 1 (n=5) received treatment with 1200 mg of SAMe (study drug) per day for 4 weeks, group 2 (n=5) received treatment with 1000 mg of chondroitin sulfate (comparator drug) per day for 4 weeks. There was a period without treatment OA (2 weeks) after 4 weeks and the patients changed OA treatment. We assessed serum cytokine levels (IL-6, IL-18) and HbA1concentrations using ELISA, and liquid chromatography, respectively. Additionally, ECR, CRP were measured from the same blood sample. Serum and blood were obtained from each patient and were isolated on baseline and at week 4 of the treatment. The studied efficacy outcomes were pain levels (VAS), functional disabilities with Knee injury and Osteoarthritis Outcome Score - (KOOS) and quality of life (QoL) with short form 36 (SF-36). Statistical data is presented as median and 25/75 percentiles. We used Wilcoxon signed-rank test to detect differences between groups.
Results Ten patients (all women, median age 66,5; IQR 61,7-74,2) were enrolled in the study. SAMe treatment was associated with significant improvement in pain score, activity by physician, KOOS and SF-36 indexes (Table). There were no differences in serum cytokine levels, HbA1c, ECR, CRP before and after the SAMe treatment. There were also no differences in clinical efficacy parameters (except KOOS symptoms p=0,02), serum cytokines concentrations, HbA1c, ECR and CRP before and after the SYSADOA (chondroitin sulfate) treatment. The SAMe and chondroitin sulfate were well tolerated, no patient experienced disease impairment during the treatment.
Conclusions In patients with knee OA and T2DM the treatment with SAMe is associated with decreased pain, improved knee function and symptoms but has no effect on proinflammatory factors production and blood glucose level. The results need to be confirmed in a randomized, double-blind trial.
Najm WI et al. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. BMC Musculoskelet Disord. 2004;5:6. Epub 2004/04/23.
Poirier LA et al. Blood S-adenosylmethionine concentrations and lymphocyte methylenetetrahydrofolate reductase activity in diabetes mellitus and diabetic nephropathy. Metabolism. 2001;50(9):1014-8. Epub 2001/09/14.
Disclosure of Interest None declared