medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-1-76-83medsovet-2902Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYБиорегуляционные препараты в терапии остеоартрозаBioregulatory drugs in osteoarthritis managementШавловскаяО. А.ShavlovskayaO. A.

д.м.н., ведущий научный сотрудник НИО неврологии Научно-технологического парка биомедицины Федерального государственного автономное образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет)

Dr. of Sci. (Med.), a lead researcher of Research Unit of Neurology of Biomedical Science and Technology Park at Federal State Autonomous Educational Institution of Higher Education «Sechenov First Moscow State Medical University» of the Ministry of Heath of the Russian Federation (Sechenov University)

shavlovskaya@1msmu.ruФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет)РоссияFederal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation201905032019017683Copyright © Шавловская О.А., 20192019Шавловская О.А.Shavlovskaya O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2902

Остеоартроз (ОА) – дегенеративно-дистрофическое заболевание суставов. Современные теории рассматривают в качестве основы острого и хронического болевого синдрома различные структурные (разрушение хряща) и биофизические нарушения (потеря матриксом гликозаминогликанов). Основная цель в терапии ОА – облегчение боли и улучшение функционального состояния. В терапии болевого синдрома при ОА оправданно назначение комплексных биорегуляционных препаратов (КБП) (Траумель С, Цель Т и Дискус композитум) как в монотерапии, так и в комплексе. Эффективность КБП сравнима с НПВП и КС.

Osteoarthritis (OA) is a degenerative joint disease. Modern theories consider various structural (cartilage destruction) and biophysical disorders (matrix loss of glycosaminoglycans) as the basis of acute and chronic pain syndrome. The main aim of OA therapy is pain relief and functional improvement. To manage pain syndrome in OA it is reasonable to use complex bioregulatory drugs (CBD) (Traumeel S, Zeel T, Discus compositum) both in monotherapy and in combined treatment. The effectiveness of CBD is comparable to that of NSAIDs and CS.

остеоартрозбиорегуляционные препаратыТраумель СЦель Т и Дискус композитумosteoarthritisbioregulatory drugsTraumel SZeel T and Discus compositumReferencesБагирова Г.Г., Майко О.Ю. Остеоартроз: эпидемиология, клиника, диагностика, лечение. Монография. М.: «Арнебия», 2005. 224 с. Доступно по: http://www.arnebia.ru/cgi-bin/ index.cgi?id = 18. Ссылка активна на 10.02.2019.Bagirova G.G., Maiko O.Yu. Osteoarthritis: epidemiology, clinic, diagnosis, treatment. Monography. М.: «Arnebiya», 2005. 224 р.] (In Russ.). Available at: http://www. arnebia.ru/cgi-bin/index.cgi?id = 18 on 10.02.2019.Кавалерский Г.М., Силин Л.Л. Применение Цель Т в ортопедии для лечения дегенеративных заболеваний (аналитический обзор). Биологическая медицина. 2011;17(2):38-47. Доступно по: http://www.arnebia.ru/cgi-bin/ index.cgi?id = 16. Ссылка активна на 10.02.2019.Kavalerskii G.M., Silin L.L. Application of Zeel T in orthopedics for the treatment of degenerative diseases (analytical review). Biological medicine. 2011;17(2):38-47.] (In Russ.). Available at: http://www.arnebia.ru/ cgi-bin/index.cgi?id = 16 on 10.02.2019.Энгельберт К. Безопасная альтернатива НПВС. Биологическая медицина. 2006;2:62 Доступно по: http://www.arnebia.ru/cgi-bin/index.cgi?id=16. Ссылка активна на 10.02.2019.Engel’bert K. A safe alternative to NSAIDs. Biological medicine. 2006;2:62.] (In Russ.). Available at: http://www.arnebia.ru/cgi-bin/ index.cgi?id = 16 on 10.02.2019.Cimmino M.A., Ferrone C., Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2011;25(2):173-183. https://doi.org/10.1016/j.berh.2010.01.012.Cimmino M.A., Ferrone C., Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2011;25(2):173-183. https://doi.org/10.1016/j.berh.2010.01.012.Лыгина Е.В. Хондропротекторы в лечении остеоартроза. Современная ревматология. 2012;6(2):59-64. https://doi.Lygina E.V. Chondroprotectors in the treatment of osteoarthritis. Modern Rheumatology Journal. 2012;6(2):59-64.] (In Russ). https://doi.org/10.14412/1996-7012-2012-729.org/10.14412/1996-7012-2012-729Шавловская О.А. Обзор зарубежной литературы по применению хондроитин сульфата. РМЖ. 2012;20(34):1678-1682. Доступно по: https://www.rmj.ru/. Ссылка активна на 10.02.2019.Shavlovskaya O.A. A review of foreign literature on the use of chondroitin sulfate. RMJ. 2012;20(34):1678-1682.] (In Russ.). Available at: https://www.rmj.ru/ on 10.02.2019.Chen L., Ling P.X., Jin Y., Zhang T.M. Hyaluronic acid in combination with chondroitin sulfate and hyaluronic acid improved the degeneration of synovium and cartilage equally in rabbits with osteoarthritis. Drug Discov Ther. 2011;5(4):190-194. https://doi.org/10.5582/ ddt.2011.v5.4.190.Chen L., Ling P.X., Jin Y., Zhang T.M. Hyaluronic acid in combination with chondroitin sulfate and hyaluronic acid improved the degeneration of synovium and cartilage equally in rabbits with osteoarthritis. Drug Discov Ther. 2011;5(4):190-194. https://doi.org/10.5582/ ddt.2011.v5.4.190.Omoigui S. The biochemical origin of pain – proposing a new law of pain: the origin of all pain is inflammation and the inflammatory response. Part 1 of 3-a unifying law of pain. Med Hypotheses. 2007;69(1):70-82. https://doi. org/10.1016/j.mehy.2006.11.028.Omoigui S. The biochemical origin of pain – proposing a new law of pain: the origin of all pain is inflammation and the inflammatory response. Part 1 of 3-a unifying law of pain. Med Hypotheses. 2007;69(1):70-82. https://doi. org/10.1016/j.mehy.2006.11.028.Терапия болевых синдромов опорно-двигательного аппарата: биорегуляторный подход. Практические аспекты применения комплексных антигомотоксических препаратов. Biologische Heilmittel Heel GmbH. 2015;1-48. www.heel.com.Therapy of locomotor apparatus pain syndromes: the bioregulatory approach. Practical aspects of complex antihomotoxic drugs use. Biologische Heilmittel Heel GmbH. 2015;1-48. www.heel.com] (In Russ.)Zimmermann G.R., Lehár J., Keith C.T. Multitarget therapeutics: when the whole is greater than the sum of the parts. Drug Discov Today. 2007;12(1/2):34–42. https://doi.org/10.1016/j. drudis.2006.11.008.Zimmermann G.R., Lehár J., Keith C.T. Multitarget therapeutics: when the whole is greater than the sum of the parts. Drug Discov Today. 2007;12(1/2):34–42. https://doi.org/10.1016/j. drudis.2006.11.008.Haseeb A., Haqqi T.M. Immunopathogenesis of osteoarthritis. Clin Immunol. 2013;146(3):185-96. https://doi.org/10.1016/j.clim.2012.12.011.Haseeb A., Haqqi T.M. Immunopathogenesis of osteoarthritis. Clin Immunol. 2013;146(3):185-96. https://doi.org/10.1016/j.clim.2012.12.011.Barabasi A.-L., Gulbahce N., Loscalzo J. Network medicine: a network-based approach to human disease. Nat Rev Genet. 2011;12(1):56-68. https://doi.org/10.1038/nrg2918.Barabasi A.-L., Gulbahce N., Loscalzo J. Network medicine: a network-based approach to human disease. Nat Rev Genet. 2011;12(1):56-68. https://doi.org/10.1038/nrg2918.Schneider C., Schneider B., Hanisch J., van Haselen R. The role of a homoeopathic preparation compared with conventional therapy in the treatment of injuries: an observational cohort study. Complement Ther Med. 2008;16(1):22–27. https://doi.org/10.1016/j. ctim.2007.04.004.Schneider C., Schneider B., Hanisch J., van Haselen R. The role of a homoeopathic preparation compared with conventional therapy in the treatment of injuries: an observational cohort study. Complement Ther Med. 2008;16(1):22–27. https://doi.org/10.1016/j. ctim.2007.04.004.Schneider C. Traumeel – an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. International Journal of General Medicine. 2011;4225-234. https://doi.org/10.2147/ijgm. s16709.Schneider C. Traumeel – an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. International Journal of General Medicine. 2011;4225-234. https://doi.org/10.2147/ijgm. s16709.McAlindon T.E., Bannuru R.R., Sullivan M.C., Arden N.K., Berenbaum F., Bierma-Zeinstra S.M., Hawker G.A., Henrotin Y., Hunter D.J., Kawaguchi H., Kwoh K., Lohmander S., Rannou F., Roos E.M., Underwoodet M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363–388. https://doi.org/10.1016/j.joca.2014.01.003.McAlindon T.E., Bannuru R.R., Sullivan M.C., Arden N.K., Berenbaum F., Bierma-Zeinstra S.M., Hawker G.A., Henrotin Y., Hunter D.J., Kawaguchi H., Kwoh K., Lohmander S., Rannou F., Roos E.M., Underwoodet M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363–388. https://doi.org/10.1016/j.joca.2014.01.003.Hochberg M.C., Altman R.D., April K.T., Benkhalti M., Guyatt G., McGowan J., Towheed T., Welch V., Wells G., Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465-474. https://doi.org/10.1002/acr.21596.Hochberg M.C., Altman R.D., April K.T., Benkhalti M., Guyatt G., McGowan J., Towheed T., Welch V., Wells G., Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465-474. https://doi.org/10.1002/acr.21596.Jevsevar D.S. Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition Journal of the American Academy of Orthopaedic Surgeons. 2013;21(9):571-576. https://doi.Jevsevar D.S. Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition Journal of the American Academy of Orthopaedic Surgeons. 2013;21(9):571-576. https://doi.org/10.5435/jaaos-21-09-571.org/10.5435/jaaos-21-09-571.Osteoarthritis: care and management in adults. Clinical guideline CG177. Methods, evidence and recommendations. National Institute for Health and Care Excellence. February 2014. 505 р. full-guideline-pdf-191761311.pdf. www. nice.org.uk/guidance/CG177Osteoarthritis: care and management in adults. Clinical guideline CG177. Methods, evidence and recommendations. National Institute for Health and Care Excellence. February 2014. 505 р. full-guideline-pdf-191761311.pdf. www. nice.org.uk/guidance/CG177Jordan K.M., Arden N.K., Doherty M., Bannwarth B., Bijlsma J.W.J., Dieppe P., et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT), Ann Rheum Dis. 2003;62(12):1145–1155. https://doi. org/10.1136/ard.2003.011742.Jordan K.M., Arden N.K., Doherty M., Bannwarth B., Bijlsma J.W.J., Dieppe P., et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT), Ann Rheum Dis. 2003;62(12):1145–1155. https://doi. org/10.1136/ard.2003.011742.Lozada C.J., del Rio E., Reitberg D.P., Smith R.A., Kahn C.B., Moskowitz R.W. Adouble-blind, randomized, saline-controlled study of the efficacy and safety of co-administered intra-articular injections of Tr14 and Ze14 for treatment of painful osteoarthritis of the knee: The MOZArT trial. European Journal of Integrative Medicine. 2017;13:54-63. https://doi.org/10.1016/j.eujim.2017.07.005.Lozada C.J., del Rio E., Reitberg D.P., Smith R.A., Kahn C.B., Moskowitz R.W. Adouble-blind, randomized, saline-controlled study of the efficacy and safety of co-administered intra-articular injections of Tr14 and Ze14 for treatment of painful osteoarthritis of the knee: The MOZArT trial. European Journal of Integrative Medicine. 2017;13:54-63. https://doi.org/10.1016/j.eujim.2017.07.005.Lozada C., del Rio E., Reitberg D., Smith R., Moskowitz R.W. A multi-center double-blind, randomized, controlled trial (db-RCT) to evaluate the effectiveness and safety of co-administered Traumeel (Tr14) and Zeel (Ze14) intraarticular (IA) injections versus IA placebo in patients with moderate-to-severe pain associated with OA of the knee. Arthritis Rheumatol 2014;66(suppl):S1266. Abstract 2896. https:// doi.org/10.1136/annrheumdis-2015-eular.4268.Lozada C., del Rio E., Reitberg D., Smith R., Moskowitz R.W. A multi-center double-blind, randomized, controlled trial (db-RCT) to evaluate the effectiveness and safety of co-administered Traumeel (Tr14) and Zeel (Ze14) intraarticular (IA) injections versus IA placebo in patients with moderate-to-severe pain associated with OA of the knee. Arthritis Rheumatol 2014;66(suppl):S1266. Abstract 2896. https:// doi.org/10.1136/annrheumdis-2015-eular.4268.Траумель С: инструкция по применению. Доступно по: https://www.rlsnet.ru/tn_index_ id_3199.htm. Ссылка активна на 10.02.2019.Traumeel S. Instructions for medical use of the drug (InRuss.). Available at: https://www.rlsnet. ru/tn_index_id_3199.htm on 10.02.2019. (In Russ).Цель Т: инструкция по применению. Доступно по: http://www.rlsnet.ru/tn_index_id_3517.htm. Ссылка активна на 10.02.2019.Zeel T: Instructions for medical use of the drug. (InRuss.).Available at: http://www.rlsnet.ru/tn_ index_id_3517.htm on 10.02.2019. (In Russ).Дискус композитум: инструкция по применению. Доступно по: https://www.rlsnet.ru/tn_ index_id_7966.htm. Ссылка активна на 10.02.2019.Discus compositum. Instructions for medical use of the drug (InRuss.). Available at: https://www.rlsnet.ru/tn_index_id_7966.htm on 10.02.2019. (In Russ).Zeel T. Effective, safe and natural therapy for osteoarthritis and rheumatic joint diseases. Product Monograph. 2013. 36р. Biologische Heilmittel Heel GmbH. Baden-Baden, Germany. First Edition: February. 2013. 079216.Zeel T. Effective, safe and natural therapy for osteoarthritis and rheumatic joint diseases. Product Monograph. 2013. 36р. Biologische Heilmittel Heel GmbH. Baden-Baden, Germany. First Edition: February. 2013. 079216.González de Vega C., Speed C., Wolfarth B., González J. Traumeel vs. diclofenac for reducing pain and improving ankle mobility after acute ankle sprain: a multicentre, randomised, blinded, controlled and non-inferiority trial. Int J Clin Pract. 2013;67(10):979-89. https://doi.González de Vega C., Speed C., Wolfarth B., González J. Traumeel vs. diclofenac for reducing pain and improving ankle mobility after acute ankle sprain: a multicentre, randomised, blinded, controlled and non-inferiority trial. Int J Clin Pract. 2013;67(10):979-89. https://doi.org/10.1111/ijcp.12219.org/10.1111/ijcp.12219.Van Hecke O., Torrance N., Smith B.H. Chronic pain epidemiology – where do lifestyle factors fit in? Br J Pain. 2013;7(4):209–217. https://doi. org/10.1177/2049463713493264.Van Hecke O., Torrance N., Smith B.H. Chronic pain epidemiology – where do lifestyle factors fit in? Br J Pain. 2013;7(4):209–217. https://doi. org/10.1177/2049463713493264.Laurent G.St., Seilheimer B., Tackett M., Zhou J., Shtokalo D., Vyatkin Y., Ri M., Toma I., Jones D., McCaffrey T.A. Deep sequencing transcriptome analysis of murine wound healing: effects of a multicomponent, multitarget natural product Therapy-Tr14. Frontiers in Molecular Biosciences. 2017;4:57. https://doi.org/10.3389/Laurent G.St., Seilheimer B., Tackett M., Zhou J., Shtokalo D., Vyatkin Y., Ri M., Toma I., Jones D., McCaffrey T.A. Deep sequencing transcriptome analysis of murine wound healing: effects of a multicomponent, multitarget natural product Therapy-Tr14. Frontiers in Molecular Biosciences. 2017;4:57. https://doi.org/10.3389/fmolb.2017.00057.fmolb.2017.00057.Stancikova M. Hemmung der Leukozytenelastase-Aktivitдt in vitro mit Zeel T, Zeel comp. und ihren verschiedenen potenzierten Bestandteilen. Biologische Medizin. 1999;28(2):83-84.Stancikova M. Hemmung der Leukozytenelastase-Aktivitдt in vitro mit Zeel T, Zeel comp. und ihren verschiedenen potenzierten Bestandteilen. Biologische Medizin. 1999;28(2):83-84.Gottwald R., Weiser M. Treatment of osteoarthritis of the knee with Zeel T. Medicina Biologica. 2000;13(4):109-113.Gottwald R., Weiser M. Treatment of osteoarthritis of the knee with Zeel T. Medicina Biologica. 2000;13(4):109-113.Lesiak A., Gottwald R., Weiser M. Skutecznosc kuracji preparatem Zeel T w iniekcjach dostawowych okolostawowych i domiesniowych w chorobie zwyrodnieniowej stawow. Medycyna Biologiczna. 2001;kwiecień czerwiec zeszyt 2:30-36.Lesiak A., Gottwald R., Weiser M. Skutecznosc kuracji preparatem Zeel T w iniekcjach dostawowych okolostawowych i domiesniowych w chorobie zwyrodnieniowej stawow. Medycyna Biologiczna. 2001;kwiecień czerwiec zeszyt 2:30-36.Майко О.Ю., Багирова Г.Г. Влияние курсового лечения с применением хондропротекторов и нестероидных противовоспалительных препаратов на качество жизни больных остеоартрозом. Клиническая медицина. 2009;87(4):47-54. PMID: 19514322.Майко О.Ю., Багирова Г.Г. Влияние курсового лечения с применением хондропротекторов и нестероидных противовоспалительных препаратов на качество жизни больных остеоартрозом. Клиническая медицина. 2009;87(4):47-54. PMID: 19514322.Birnesser H., Klein P., Weiser M. Modernes Homöopathikum ist COX 2-Hemmern ebenbürtig. Der Allgemeinarzt. 2003;25(4):261-264.Birnesser H., Klein P., Weiser M. Modernes Homöopathikum ist COX 2-Hemmern ebenbürtig. Der Allgemeinarzt. 2003;25(4):261-264.Bossche V.L., Vanderstraeten G. A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol. BMC Musculoskelet Disord. 2015;16:8. https://doi.org/10.1186/ s12891-015-0471-z.Bossche V.L., Vanderstraeten G. A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol. BMC Musculoskelet Disord. 2015;16:8. https://doi.org/10.1186/ s12891-015-0471-z.Popovich S. Treatment of knee osteoarthritis with combination of Traumeel S and Zeel T: review MOZArT clinical investigation. Orthopaedics, traumatology and prosthetics. 2015;4:81-84. https://doi.org/10.15674/0030-59872015481-84.Popovich S. Treatment of knee osteoarthritis with combination of Traumeel S and Zeel T: review MOZArT clinical investigation. Orthopaedics, traumatology and prosthetics. 2015;4:81-84. https://doi.org/10.15674/0030-59872015481-84.Попович С.В., Иванушко О.В. Траумель С: биорегуляционный подход к противоболевой терапии заболеваний позвоночника и суставов. Практична медицина. 2016;3(23):51-56. https://doi.org/10.22141/2224-1507.3.23.2016.85007.Popovych S.V., Ivanushko O.V. Traumeel S: bioregulatory approach to analgesic therapy of spine and joints diseases. Practical Medicine. 2016;3(23):51-56. https://doi. org/10.22141/2224-1507.3.23.2016.85007 (In Russ).Степанова Л.В. Практический опыт антигомотоксической терапии заболеваний суставов в условиях санатория. Биологическая медицина. 2000;1:49-50.Stepanova L.V. Practical experience of antihomotoxic therapy of illnesses of the joints in the conditions of sanatorium. Biological medicine. 2000;1:49-50 (In Russ).Моцарь С.И., Игнатьев Е.О. Опыт применения антигомотоксических препаратов Traumeel S, Zeel T, Discus compositum в терапии деформирующих артрозов, спондилоартрозов и остеохондроза позвоночника. Биологическая терапия. 2000;2:34-42.Motsar’ S.I., Ignat’ev E.O. Experience in the use of antihomotoxic drugs Traumeel S, Zeel T, Discus compositum in the treatment of deforming arthrosis, spondylarthrosis and osteochondrosis of the spine. Biological therapy. 2000;2:34-42. (In Russ).Цурко В.В., Шавловская О.А. Комплексный подход в терапии остеоартроза: в фокусе гомеопатический препарат Цель Т. РМЖ. 2014;22(27):1989-1993. Доступно по: https:// www.rmj.ru/ Ссылка активна на 10.02.2019.Tsurko V.V., Shavlovskaya O.A. An integrated approach in the treatment of osteoarthritis: the focus of homeopathic medicine Zeel T. RMJ. 2014;22(27):1989-1993. (In Russ.). Available at: https://www.rmj.ru/ on 10.02.2019.Гаркави А., González de Vega C., Speed C., Wolfarth B., Warden S. Резюме клинических данных Траумель. Доказательная база для Траумель. Biologische Heilmittel Heel GmbH, Dr. Reckeweg-Strase 2-4, 76532, Baden-Baden, Germany. 2015; 1-80.Garkavi A., González de Vega C., Speed C., Wolfarth B., Warden S. Summary of Traumeel’s clinical data. Evidence base for Traumeel. Biologische Heilmittel Heel GmbH, Dr. Reckeweg-Strase 2-4, 76532, Baden-Baden, Germany. 2015; 1-80. (In Russ).

The authors declare that there are no conflicts of interest present.