Main Article Content
The various Rheumatology/Osteoarthritis Societies (the American College of Rheumatology, the Arthritis Foundation, the European League Against Rheumatism, the National Institute for Health and Care Excellence, the European society for clinical and economic aspects of osteoporosis and osteoarthritis, and the Italian consensus on appropriateness of osteoarthrosis therapies) published specific recommendations for the management of osteoarthrosis affecting hand, hip and knee. These evidence-based guidelines take into account safety and tolerability of pharmacological and non-pharmacological interventions available from the scientific literature as well as the opinions of the clinical specialists to provide complete, clear and transparent recommendations for the management of osteoarthrosis. This article provides an update of the scientific literature for selected treatments of osteoarthrosis focusing on the therapy with symptomatic slow-acting drugs (SYSADOAs) and disease modifying anti-osteoarthrosis drugs (DMOADs) (chondroitin sulfate, glucosamine, diacerein, unsaponifiable soy and avocado extracts). Moreover, the management of osteoarthrosis pain and function, avoidance of adverse events and long-term outcomes by SYSADOAs/DMOADs molecules is considered. Finally, based on the real-world data, the opinion of the various Rheumatology/Osteoarthritis Societies of all over the word is illustrated and discussed also by considering the structure, quality and properties of the SYSADOAs/DMOADs agents used in the treatment of osteoarthrosis. In particular, the results reported in numerous studies are contradictory and not always convincing about the efficacy of chondroitin sulfate and glucosamine as SYSADOAs and DMOADs. The cause of these non-homogeneous results could be due to the use in different studies of chondroitin sulfate and glucosamine preparations of varying quality. It is therefore mandatory to carry out new clinical studies using chondroitin sulfate and glucosamine of pharmaceutical grade or of the best possible quality to ascertain their usefulness as biomolecules in the treatment of osteoarthrosis.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Volpi N. Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. Journal of Pharmacy and Pharmacology. 2009 Oct;61(10):1271-80.
3. du Souich P. Absorption, distribution and mechanism of action of SYSADOAS. Pharmacology & Therapeutics. 2014 Jun;142(3):362-74.
4. Roman-Blas JA, Bizzi E, Largo R, Migliore A, Herrero-Beaumont G. An update on the up and coming therapies to treat osteoarthritis, a multifaceted disease. Expert Opinion on Pharmacotherapy. 2016 Sep;17(13):1745-56.
5. Qvist P, Bay-Jensen AC, Christiansen C, Dam EB, Pastoureau P, Karsdal M. The disease modifying osteoarthritis drug (DMOAD): Is it in the horizon? Pharmacological Research. 2008 Jul;58(1):1-7.
6. Volpi N. Chondroitin Sulfate Safety and Quality. Molecules. 2019 Apr 12;24(8):1447.
7. Volpi N. Analytical aspects of pharmaceutical grade chondroitin sulfates. Journal of Pharmaceutical Sciences. 2007 Dec;96(12):3168-80.
8. Maccari F, Galeotti F, Volpi N. Isolation and structural characterization of chondroitin sulfate from bony fishes. Carbohydrate Polymers. 2015 Sep 20;129:143-7.
9. Volpi N. About oral absorption and human pharmacokinetics of chondroitin sulfate. Osteoarthritis and Cartilage. 2010 Aug;18(8):1104-5.
10. Mizumoto S, Yamada S, Sugahara K. Molecular interactions between chondroitin-dermatan sulfate and growth factors/receptors/matrix proteins. Current Opinion in Structural Biology. 2015 Oct;34:35-42.
11. Bishnoi M, Jain A, Hurkat P, Jain SK. Chondroitin sulphate: a focus on osteoarthritis. Glycoconjugate Journal. 2016 Oct;33(5):693-705.
12. Volpi N. Anti-inflammatory activity of chondroitin sulphate: new functions from an old natural macromolecule. Inflammopharmacology. 2011 Dec;19(6):299-306.
13. Dalirfardouei R, Karimi G, Jamialahmadi K. Molecular mechanisms and biomedical applications of glucosamine as a potential multifunctional therapeutic agent. Life Sciences. 2016 May 1;152:21-9.
14. Bruyère O, Altman R, Reginster J-V. Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Seminars in Arthritis and Rheumatism. 2016 Feb;45(4 Suppl):S12-7.
15. European Medicines Agency. EMEA public statement on the suspension of the marketing authorization for Bextra (valdecoxib) in the European Union [online], (2005) Available at http://www.ema.europa.eu/docs/en_GB/document_library/Public_statement/2009/12/WC500018391.pdf.
16. Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2018 Jul 6;13(1):170.
17. Roman-Blas JA, Castañeda S, Sánchez-Pernaute O, Largo R, Herrero-Beaumont G. Combined treatment with chondroitin sulfate and glucosamine sulfate shows no superiority over placebo for reduction of joint pain and functional impairment in patients with knee osteoarthritis: a six-month multicenter, randomized, double-blind, Placebo-Controlled Clinical Trial. Arthritis & Rheumatology. 2017 Jan;69(1):77-85.
18. Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Archives of Internal Medicine. 2003 Jul 14;163(13):1514-22.
19. Monfort J, Martel-Pelletier J, Pelletier J-P. Chondroitin sulphate for symptomatic osteoarthritis: critical appraisal of meta-analyses. Current Medical Research and Opinion. 2008 May;24(5):1303-8.
20. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. The New England Journal of Medicine. 2006 Feb 23;354(8):795-808.
21. Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO 3rd, Harris CL, Singer NG, Bradley JD, Silver D, Jackson CG, Lane NE, Oddis CV, Wolfe F, Lisse J, Furst DE, Reda DJ, Moskowitz RW, Williams HJ, Clegg DO. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis & Rheumatology. 2008 Oct;58(10):3183-91.
22. Vaishya R, Agarwal AK, Shah A, Vijay V, Vaish A. Current status of top 10 nutraceuticals used for Knee Osteoarthritis in India. Journal of Clinical Orthopaedics and Trauma. 2018 Oct-Dec;9(4):338-348.
23. Belcaro G, Dugall M, Luzzi R, Ledda A, Pellegrini L, Cesarone MR, Hosoi M, Errichi M, Francis S, Cornelli U. FlexiQule (Boswellia extract) in the supplementary management of osteoarthritis: a supplement registry. Minerva Medica. 2014 Dec;105(6 Suppl 2):9-16.
24. Belcaro G, Dugall M, Luzzi R, Ledda A, Pellegrini L, Hu S, Ippolito E. Management of osteoarthritis (OA) with the pharma-standard supplement FlexiQule (Boswellia): a 12-week registry. Minerva Gastroenterologica e Dietologica. 2015 Oct 22. Online ahead of print.
25. Almezgagi M, Zhang Y, Hezam K, Shamsan E, Gamah M, Al-Shaebi F, Abbas AB, Shoaib M, Saif B, Han Y, Jia R, Zhang W. Diacerein: Recent insight into pharmacological activities and molecular pathways. Biomedicine and Pharmacotherapy. 2020 Nov;131:110594.
26. Ernst E. Avocado-soybean unsaponifiables (ASU) for osteoarthritis - a systematic review. Clinical Rheumatology. 2003 Oct;22(4-5):285-8.
27. Saengnipanthkul S, Waikakul S, Rojanasthien S, Totemchokchyakarn K, Srinkapaibulaya A, Cheh Chin T, Mai Hong N, Bruyère O, Cooper C, Reginster JY, Lwin M. Differentiation of patented crystalline glucosamine sulfate from other glucosamine preparations will optimize osteoarthritis treatment. International Journal of Rheumatic Diseases. 2019 Mar;22(3):376-385.
28. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research (Hoboken). 2020 Feb;72(2):149-162.
29. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. National Health Statistics Reports. 2015 Feb 10;(79):1-16.
30. Biggee BA, Blinn CM, Nuite M, Silbert JE, McAlindon TE. Effects of oral glucosamine sulphate on serum glucose and insulin during an oral glucose tolerance test of subjects with osteoarthritis. Annals of the Rheumatic Diseases. 2007 Feb;66(2):260-2.
31. Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dinçer F, Dziedzic K, Häuselmann HJ, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Annals of the Rheumatic Diseases. 2007 Mar;66(3):377-88.
32. Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, Haugen IK, Herrero-Beaumont G, Jonsson H, Kjeken I, Maheu E, Ramonda R, Ritt MJ, Smeets W, Smolen JS, Stamm TA, Szekanecz Z, Wittoek R, Carmona L. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019 Jan;78(1):16-24.
33. National Clinical Guideline Centre, Clinical guideline CG177. Osteoarthritis: Care and Management in Adults. London: National Institute for Health and Care Excellence (UK), 2014.
34. Bruyère O, Cooper C, Pelletier JP, Maheu E, Rannou F, Branco J, Luisa Brandi M, Kanis JA, Altman RD, Hochberg MC, Martel-Pelletier J, Reginster JY. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Seminars in Arthritis and Rheumatism. 2016 Feb;45(4 Suppl):S3-11.
35. Bruyère O, Cooper C, Al-Daghri NM, Dennison EM, Rizzoli R, Reginster JY. Inappropriate claims from non-equivalent medications in osteoarthritis: a position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging clinical and experimental research. 2018 Feb;30(2):111-117.
36. Bernetti A, Mangone M, Villani C, Alviti F, Valeo M, Grassi MC, Migliore A, Viora U, Adriani E, Quirino N, Fioravanti A, Paoloni M. Appropriateness of clinical criteria for the use of SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOA). A Delphi Method Consensus initiative among experts in Italy. European Journal of Physical and Rehabilitation Medicine. 2019 Oct;55(5):658-664.
37. Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, Mokhtar SA, Nakata K, Navarra SV, Nguyen VH, Pinzon R, Tsuruoka S, Yim HB, Choy E. Practice advisory on the appropriate use of NSAIDs in primary care. The Journal of Pain Research. 2020 Aug 3;13:1925-1939.
38. Jüni P, Reichenbach S, Dieppe P. Osteoarthritis: rational approach to treating the individual. Best Practice & Research: Clinical Rheumatology. 2006 Aug;20(4):721-40.