In the current age of the Internet and skillfully presented information, any competent patient can tell you what is necessary to treat joints: you need to restore articular cartilage and you need to replenish the “lubrication” of the joint, i.e. intra-articular fluid. This goal seems to be best met by the prescription of drugs from the group of chondroprotectors.
The cost of these drugs is off the charts; the effect of their use is expected to be fabulous. But in reality, as a rule, regular use of chondroprotectors leads to disappointment for patients. What kind of drugs are these? And are they really as effective as advertising materials promise us?
Chondroprotectors(chondros-cartilage, protector) - literally: substances that protect cartilage (in particular, articular cartilage). This group of drugs has appeared quite recently. The second generation of drugs has been around for just over 10 years.
Depending on the time of development, there are 3 generations of chonroprotective drugs:
I generation (natural origin):
- animal origin (based on bone marrow and cartilage tissue of animals and fish) - Alflutop, Rumalon
- mucopolysaccharides - Arteparon (Mucartrin)
II generation(synthetic monodrugs)
- based on chondroitin sulfate - Mucosat, Chondroxide, Structum, Honsurid, Chondrolone, Chondrogard, Chondrosat, Artradol, Artiflex, Arthrox, Artrida, Toad Stone balm (dietary supplement)
- based on glucosamine - Dona, Artron flex, Sustilak, Elbona, Sinarta
III generation (complex synthetic drugs combining chondroitin sulfate with glucosamine) - Theraflex, Artra, Artron Complex, Chondroitin-complex, Formula-S, CONDROnova, Movex, Chondro-sila, Protekon, Inoltra (dietary supplement)
Chondroprotectors combined with non-steroidal anti-inflammatory drugs are now being developed and produced. For example, Teraflex Advance (a combination of ibuprofen, glucosamine sulfate and chondroitin sulfate). Some researchers classify combinations of chondroprotectors with drugs from other groups as a new, IV generation.
As a marketing ploy, the name “colloids” is sometimes used for some chondroprotective dietary supplements produced in the form of solutions. Although the name colloids does not characterize this specific group of drugs, but only one of the types of all existing solutions.
Separately, we should highlight intra-articular fluid substitutes (prostheses) - preparations for intra-articular administration based on hyaluronic acid or polymers. These are Ostenil, Synvisc, Orthovisc, Gialgan, Gialual, Giastat, Gialurom, Giruan, Sinokrom, Suparts, Fermathron, Durolan, Coxartrum, ViscoPlus, Go-on, Euflexa, Hialubrix, Adant, Noltrex.
Abroad, the group of chondroprotectors is called SYSADOA (Symptomatic Slow Acting Drags of Osteoarthritis - symptomatic slow-acting drugs against osteoarthritis)
What chondroprotector manufacturers say?
As the manufacturers indicate, due to the fact that chondroprotectors contain components of articular cartilage, which, when entering the body, are included in the composition of damaged cartilage and contribute to its renewal, they:
- promote the restoration of articular cartilage tissue and also protect it from further destruction.
- they also contribute to the normalization of both the quantity and quality of intra-articular (synovial) fluid.
In addition, the constituent substances of chondroprotectors have a moderate anti-inflammatory effect as an additional effect.
As a result of this effect, the patient’s pain is reduced, joint function is restored and articular cartilage is strengthened.
The therapeutic effect develops after long-term use of the drugs. Usually no less than 3 weeks, and most often after 3-6 months.
It should be noted that, guided by this logic (to replenish diseased components of the joints with sources from outside), people who have suffered from arthrosis for many years often do this. They try to eat jellied meat, gelatin, or just a decoction of seeds. And taking the comparison to the level of grotesquery, one can recall the North American Indians who eat the heart of a defeated enemy, but who was brave during his lifetime, in order to gain his courage.
And chondroprotectors should affect not only articular cartilage, but also all cartilage of the body (including ear, nasal cartilage, etc.).
But the moderate anti-inflammatory effect of chondroprotectors needs to be taken a closer look.
Long-term practice demonstrates the controversial effectiveness of chondroprotectors
Butmany years of practice demonstrate the controversial effectivenessof a group of drugs - chondroprotectors. We regularly encounter patients who take chondroprotectors daily for several years and do not notice any therapeutic effect from them. They continue to take these drugs, apparently due to inertia and the ongoing intense influence of advertising information. Despite this, they continue to be widely prescribed by doctors and used by patients with joint and spine problems.
The initially declared effect of restoring articular cartilage has not yet found any confirmation. To determine whether articular cartilage has been restored, it is enough to compare conventional x-rays of the diseased joint taken before and after treatment with chondroprotectors. The height of the joint space indirectly indicates the thickness of the articular cartilage layer. Thus, after restoration of the cartilage, the height of the joint space should increase. Unfortunately, this has never happened before. The height of the joint space always remains unchanged, or even decreases.
At best, only the effect of protecting articular cartilage from further destruction is observed during the period of taking these drugs. But he is also doubtful.
Also, many questions arise about thebioavailabilityof various forms of drugs. What is the actual amount of the active substance that gets into the affected joint if the drug is not administered directly into the joint, but is taken orally (in the form of tablets, powders), in the form of intramuscular injections, and even more so in the form of ointments. Apparently, with such methods of administration, only a symbolic amount of the drug reaches the desired area.
Why is there sometimes a positive effect when taking chondroprotectors??
Despite all the above circumstances, a relatively small proportion of patients sometimes develop a positive effect after taking chondroprotectors.
In the vast majority of cases, these are patients in mild stages of the disease. In advanced cases of disease, the effectiveness of chondroprotectors is close to zero.
What can this improvement in condition be associated with in some patients, if taking chondroprotectors does not cause restoration of articular cartilage? And if there is no clear data on the improvement of cartilage condition as a result of taking chondroprotectors? The positive effect in these cases can be explained by not a chondroprotective effect, but an anti-inflammatory one. The mechanism of action of chondroprotectors is associated with stimulation of chondrocyte function, decreased activity of lysosomal enzymes (metalloproteinases), and increased resistance of chondrocytes to the effects of proinflammatory cytokines. Those. chondroprotectors have the same effect as non-steroidal anti-inflammatory drugs (NSAIDs) - Diclofenac, Movalis, Ortofen and many others. True, the anti-inflammatory effect of chondroprotectors is weaker than that of NSAIDs and develops over a long period of time.
Yes, NSAIDs can cause various side effects when taken for a long time (primarily by affecting the gastric mucosa). But chondroprotectors, when taken long-term (and they are recommended to be taken for many months), can also cause side effects. A natural question arises: in this case, isn’t it better to use non-steroidal anti-inflammatory drugs?
Let’s even express such a “seditious” thought: maybe there is no medicinal group of chondroprotectors (in the sense that there are no drugs that “protect” articular cartilage)? Maybe the so-called chondroprotectors should be classified as anti-inflammatory drugs with moderate activity? Then non-steroidal anti-inflammatory drugs (NSAIDs) are more active anti-inflammatory drugs. And the most active are hormonal anti-inflammatory drugs (glucocorticoids). In this case, everything falls into place.
It is not without reason that the most modern chondroprotectors try to include non-steroidal anti-inflammatory drugs (for example, Teraflex Advance). The efforts of pharmacists are directed not at protecting and “restoring” cartilage, but at enhancing the fight against inflammation.
Also, do not forget about the banalself-hypnosis effectcaused by an aggressive advertising campaign.
It should also be remembered that, according to the recommendations of the developers of chondroprotective drugs themselves, it makes sense to prescribe them only in the initial and middle stages of arthrosis (I and II). In advanced stages (III and IV), there are no indications for prescribing chondroprotectors, even according to the official version.
Unbiased research
Here are just some data from unbiased foreign studies published in authoritative publications in the USA and Great Britain:
- The New England Journal of Medicine (2006): The conclusion of a meta-study conducted on a group of 1583 patients: chondroitin sulfate, glucosamine and any combination of them did not surpass the effect obtained with a conventional placebo.
- American College of Physicians (2007): Large-scale studies indicate that the symptomatic benefit of chondroitin is minimal or non-existent. The use of chondroitin in routine clinical practice should therefore be rethought.
- The BMJ: leading general medical journal (2010): conclusions based on 10 studies conducted on a group of 3803 patients: compared with placebo, chondroitin and glucosamine and their combinations did not show any benefit.
What do you think about the advisability of using chondroprotectors??
