Background A significant prevalence of osteoarthritis (OA), the most disability joint disease in the world, which is important in the search for the new treatment. Analysis of modern therapy of OA was the reason for research efficacy of NSAIDs and SYSADOA on biochemical, inflammatory and immunological signs in the treatment of OA.
Objectives Differentiated approach to the treatment of OA depending of presence of hyperuricemia.
Methods 176 patients (144 women, 32 men) was exanimated, aged (59,71±0,86) years with confirmed radiographic OA according to Kellgren and Lawrence scale. Division into groups was performed depending on treatment. For 14 days group 1 (n=30) received nimesulide 100 mg twice daily, and group 2 (n=30) - meloxicam 15 mg 1 per day. For 6 months 3rd group (n=54) received diacerein 50 mg twice a day and the 4th group (n=32) - chondroitine sulfate (CS) 500 mg twice daily. 5th group (n=30) received glucosamine sulfate (GS) 400 mg 3 times per week for 1.5 months. It was estimated dynamics of VAS, WOMAC, Lequesne, uric acid (UA), CRP, IL-1β, IGF-1, NO, ESR, biochemical indicators. Statistical analysis - SPSS Statistics.
Results Nimesulide compared to meloxicam found more effective for WOMAC index, the reduction of pain, stiffness and functional failure 53.93% vs 37.3%, 29.7% vs 13.5%, 41.6% vs 26.6% respectively. Only nimesulide decreased NO by 40.2%, and showed a decrease trend of UA from 375,33±24,6 to 321,57±19,6 mkmol/l while meloxicam had no effect on their levels. In 60% of patients with OA was found hyperuricemia with nephrolithiasis. Was showed the relation between the severity of OA and the presence of hyperuricemia by VAS, Lequesne, WOMAC, lesions more number joints, higher stage of X-ray progress. Diacerein, CS and GS showed clinical effect on pain reduction by VAS, Lequesne, WOMAC (p<0.05), respectively. Was showed lower levels of CRP, IL-1, NO during treatment by diacerein (CRP from 5,6 (IQR: 3,6–8,0) to 3,0 (IQR: 1,95–4,3) mg/l, IL-1 from 19,47 (IQR: 15,22–23,81) to 12,0 (IQR: 9,0–16,2) pg/ml, NO of 4,09 (IQR: 3,0–4,19) to 2,2 (IQR: 1,0–3,44) mmol/l), CS (CRP from 6,0 (IQR: 3,25–9,0) to 3,10 (IQR: 1,81–6,0) mg/l, IL-1 20,0 (IQR: 11,5–26,52) pg/ml to 16,7 (IQR: 9,80–18,62) pg/ml, NO of 3,0 (IQR: 2,05–4,00) to 2,0 (IQR: 2,0–3,0) mmol/l) and GS (CRP from 6,0 (IQR: 4,0–8,45) to 4,0 (IQR: 4,0–6,0) mg/l, IL-1 from 4,69 (IQR: 2,5–7,59) to 2,52 (IQR: 1,75–3,94) pg/ml, NO 3,28 (IQR: 2,02–4,79) to 2,37 (IQR: 1,59–3,03) mmol/l) (p<0,05). Diacerein reduced UA from 415,5 (IQR: 347,0–452,5) to 374,0 (IQR: 318,75–423,5) mkmol/l (p=0.001) and glucose from 5,1 (IQR: 4,8–5,8) mmol/l to 4,88 (IQR: 4,00–5,40) mmol/l (p=0.0001). CS in patients with hyperuricemia (p=0.001) increased the level of UA, which reduced the efficacy of CS, but without hyperuricemia didn't influence the level of UA and efficacy of CS.
Conclusions Was showed that nimesulide is more effective than meloxicam during first 14 days, and reduces NO, an important proinflammatory factor. The presence of hyperuricemia in 60% patients with OA, resulted in a more severe OA. Diacerein decreases UA and glucose, given an advantage in treatment these patients, which isn't presented with CS (which increased UA).
National Clinical Guideline Centre. Osteoarthritis. Clinical guideline CG177; 2014.
Hyperuricemia and the risk for subclinical coronary atherosclerosis – data from a prospective observational cohort study. Krishnan E. et al. Arthritis Res. Ther. 2011;13(2):66.
Disclosure of Interest None declared