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NEW OPPORTUNITIES THERAPY IN PATIENTS WITH KNEE JOINT OSTEOARTHRITIS AND METABOLIC SYNDROME

https://doi.org/10.21518/2079-701X-2018-1-86-96

Abstract

Objective/introduction. Evaluation of efficacy and safety of diacerein therapy in patients with knee joint osteoarthritis (OA) and metabolic syndrome (MS). Materials and methods. 55 outpatients (50 women and 5 men) with MS and stage 2-3 OA of knee joint according to Kellgren-Lawrence, with intensity of pain syndrome > 40 mm according to visual analogue scale (VAS) from 4 Russian Federation subjects were enrolled in the study. Average age of patients was 59.7 ± 7.3 years , mean BMI is 33 ± 5,49 kg/m2, the duration of the disease is 8 (5-10 years). Duration of the study was 9 months (6 months of therapy: 1 capsule (50 mg) per day for the first month, 2 capsules (100 mg) per day for the next 5 months, and follow-up for 3 months). Evaluation of the efficacy and safety of the treatment was conducted according to generally accepted criteria. All patients were underwent biochemical tests at the beginning and at the end of therapy. Results. The study resulted in a statistically significant reduction in pain when walking according to VAS as early as in 1 month from the beginning of treatment; the further significant improvement was observed during the entire 6-month therapy. Withdrawal of therapy (the observation period was 3 months) didn’t increase the pain syndrome. Evaluation according to Womac index also revealed identical regularity. A statistically significant improvement in the quality of life according to EQ-5D was also identified during the whole period of observation. By the end of the therapy, 92.5% of the patients were OMERACT - OARSI - responders and 64.2% of patients had completely withdrawn from NSAID. Against the background of the therapy, there was a significant decrease in BMI, LDL, TG, glucose, uric acid levels. Conclusion: The data obtained make it possible to recommend diacerein as a basic therapy for OA in patients with MS. On the background of therapy, the patients showed statistically significantly reduction in pain, stiffness, the need for NSAIDs, improved the quality of life and the function of the joints. In addition, the body weight decreases reliably, the lipidogram, carbohydrate and protein metabolism parameters also improved.

 

About the Authors

L. I. Alexeeva
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
MD, Prof


E. A. Taskinа
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


N. G. Kashevarova
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


E. P. Sharapova
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


S. G. Anikin
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


E. A. Strebkova
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


T. A. Korotkova
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation
PhD in medicine


T. A. Raskina
Kemerovo State Medical University
Russian Federation
MD, Prof


E. V. Zonova
Novosibirsk State Medical University
Russian Federation
MD, Prof


E. N. Oteva
Khabarovsk Institute of Advanced Training of Health Professionals
Russian Federation
MD, Prof


A. G. Dilbaryan
Nasonova Research Institute of Rheumatology, Moscow
Russian Federation


References

1. World Health Organization. Obesity: Preventing And Managing The Global Epidemic. 1997, Geneva.

2. Blagojevic M, Jinks C, Jeffery A, Jordan Kp. Risk Factors For Onset Of Osteoarthritis Of The Knee In Older Adults: A Systematic Review And Meta-Analysis. Osteoarthritis Cartilage, 2010 Jan, 18(1): 24-33. doi: 10.1016/J.Joca.2009.08.010.

3. Fu Y, Griffin TM. Obesity, Osteoarthritis And Aging: The Biomechanical Links. Mechanobiology Of Obesity And Related Diseases. Springer International Publishing, 2015: 181-201.

4. Кашеварова Н.Г., Алексеева Л.И., Таскина Е.А., Смирнов А.В. Ведущие факторы прогрессирования остеоартрита коленных суставов. Влияние симптоматических препаратов замедленного действия на течение заболевания (5-летнее проспективное исследование). Фарматека, 2017, 7(340): 40-45.

5. Wang H et al. Metabolic Syndrome Increases The Risk For Knee Osteoarthritis: A Meta-Analysis. Evid Based Complement Alternat Med, 2016, 2016: 7242478.

6. Morley Je, Sinclair A. The Metabolic Syndrome In Older Persons: A Loosely Defined Constellation Of Symptoms Or A Distinct Entity? Age Ageing, 2009, 38(5): 494-7. doi: 10.1093/Ageing/Afp105. Epub 2009 Jul 2.

7. Тареев Е.М. Гипертоническая болезнь. М.: Медгиз, 1948. 156 с.

8. Hanefeld M, Schaper F, Ceriello A. Geschichte Und Definition (En) Des Metabolischen Syndroms. Internist, 2007, 48: 117-25.

9. Диагностика и лечение метаболического синдрома. Сборник национальных клинических рекомендаций. М.: Силицея – Полиграф, 2009: 106-143.

10. Стребкова Е.А., Алексеева Л.И. Остеоартроз и ожирение. Научно-практическая ревматология, 2015, 53(5): 542-552.

11. Singh G, Miller JD, Lee FH, Pettitt D, and Russell MW. Prevalence Of Cardiovascular Disease Risk Factors Among Us Adults With Self-Reported Osteoarthritis: Data From The Third National Healt Hand Nutrition Examination Survey. American Journal Of Managed Care, 2002, 8(15): 383–391.

12. Shin D. Association Between Metabolic Syndrome, Radiographic Knee Osteoarthritis, And Intensity Of Knee Pain: Results Of A National Survey. J. Clin. Endocrinol. & Metab., 2014, 99(9): 3177–3183.

13. Velasquez MT, Katz JD. Osteoarthritis: Another Component Of Metabolic Syndrome? Metab. Syndr. Relat. Disord., 2010, 8(4): 295–305.

14. Yoshimura N, Muraki S, Oka H, Tanaka S, Kawaguchi H, Nakamura K, Akune T. Accumulation Of Metabolic Risk Factors Such As Overweight, Hypertension, Dyslipidaemia, And Impaired Glucose Tolerance Raises The Risk Of Occurrence And Progression Of Knee Osteoarthritis: A 3-Year Follow-Up Of The Road Study. Osteoarthritis Cartilage, 2012 Nov, 20(11): 1217-26. doi: 10.1016/j. joca.2012.06.006.

15. Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T. A ssociation Of Knee Osteoarthritis With The Accumulation Of Metabolic Risk Factors Such As Overweight, Hypertension, Dyslipidemia,And Impaired Glucose Tolerance In Japanese Men And Women: The Road Study. J Rheumatol., 2011, 38(5): 921-30. doi: 10.3899/Jrheum.100569.

16. Abourazzak F, Talbi S, Lazrak F, Azzouzi H, Aradoini N, Keita S, Errasfa M, Harzy T. Does Metabolic Syndrome Or Its Individual Components Affect Pain And Function In Knee Osteoarthritis Women? Curr Rheumatol Rev, 2015 May 21.

17. Chadha R. Revealed aspect of metabolic osteoarthritis. J Orthop, 2016 Jul 9, 13(4): 347-51. doi: 10.1016/j.jor.2016.06.029. eCollection 2016 Dec.

18. Farnaghi S, Crawford R, Xiao Y, Prasadam I. Cholesterol metabolism in pathogenesis of osteoarthritis disease. Int J Rheum Dis, 2017 Feb, 20(2): 131-140. doi: 10.1111/1756-185X.13061. Epub 2017 Apr 5.

19. Dellisola A, Allan R, Smith S, Marreiros Ss, Steultjens M. Identification Of Clinical Phenotypes In Knee Osteoarthritis: A Systematic Review Of The Literature. BMC mus-culoskelet disord, 2016 Oct 12, 17(1): 425. doi: 10.1186/s12891-016-1286-2.

20. Martel-Pelletier J, Pelletier JP. Effects of diacerein at the molecular level in the osteoarthritis disease process. Ther Adv Musculoskelet Dis, 2010 Apr, 2(2): 95-104. doi: 10.1177/1759720X09359104.

21. Steinecker-Frohnwieser B, Kaltenegger H, Weigl L, Mann A, Kullich W, Leithner A, Lohberger B. Pharmacological treatment with diacerein combined with mechanical stimulation affects the expression of growth factors in human chondrocytes. Biochem Biophys Rep, 2017 Jul 1, 11: 154-160. doi: 10.1016/j. bbrep.2017.06.006.

22. Sun H, Luo G, Chen D, Xiang Z. A Comprehensive and System Review for the Pharmacological Mechanism of Action of Rhein, an Active Anthraquinone Ingredient. Front Pharmacol, 2016 Aug 17, 7: 247. doi: 10.3389/fphar.2016.00247. eCollection 2016.

23. Алексеева Л.И., Кашеварова Н.Г., Таскина Е.А., Шарапова Е.П., Аникин С.Г., Короткова Т.А., Стребкова Е.А. Эффективность и безопасность диацереина у пациентов с остеоартритом коленных суставов. Современная ревматология, 2017, 11(3): 50–57.

24. Шарапова Е.П., Кашеварова Н.Г., Зайцева Е.М., Аникин С.Г., Короткова Т.А., Алексеева Л.И. Оценка эффективности и безопасности диацереина у пациентов с остеоартрозом тазобедренных суставов. Медицинский совет, 2017, 1s: 84-89.

25. Каратеев А.Е., Алексеева Л.И., Цурган А.В., Гонтаренко Н.В. Оценка эффективности и безопасности комплексной терапии скелетно-мышечной боли с использованием Диацереина (по данным исследования РОКАДА – ретроспективная оценка клинических аспектов применения диафлекса при остеоартрозе). Неврология и ревматология. Приложение к журналу Consilium Medicum, 2016, 2: 26-32.

26. Pavelka K, Bruyere O, Cooper C et al. Diacerein: Benefits, Risks and Place in the Management of Osteoarthritis. An Opinion-Based Report from the ESCEO. Drugs Aging, 2016, 33(2): 75–85. doi: 10.1007/s40266-016-0347-4.

27. Assessment report for diacerein containing medicinal products. 28 August 2014 EMA/527347/2014. http: //www.ema.europa. eu/.

28. Joo NS, Kim SM, Kim KM, Kim CW, Kim BT, Lee DJ. Changes of body weight and inflammatory markers after 12-week intervention trial: results of a double-blind, placebo-control pilot study. Yonsei Med J, 2011 Mar, 52(2): 242-8. doi: 10.3349/ymj.2011.52.2.242.

29. Наумов А.В., Ховасова Н.О. Рекомендованная терапия остеоартрита: новые решения старых задач. РМЖ, 2016, 24(3): 197-202.

30. Ramos-Zavala MG, Gonzalez-Ortiz M, Martinez-Abundis E, Robles-Cervantes JA, Gonzalez-Lopez R, Santiago-Hernandez NJ. Effect of diacerein on insulin secretion and metabolic control in drug-naive patients with type 2 diabetes: a randomized clinical trial. Diabetes Care, 2011 Jul, 34(7): 1591-4. doi: 10.2337/dc11-0357.

31. Villar MM, Martinez-Abundis E, Preciado-Mаrquez RO, Gonzalez-Ortiz M.Effect of diacerein as an add-on to metformin in patients with type 2 diabetes mellitus and inadequate glycemic control. Arch Endocrinol Metab, 2017 Mar-Apr, 61(2): 188-192. doi: 10.1590/2359-3997000000242.

32. Cardoso CRL, Leite NC, Carlos FO, Loureiro AA, Viegas BB, Salles GF. Efficacy and Safety of Diacerein in Patients With Inadequately Controlled Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care, 2017 Aug 17. pii: dc170374. doi: 10.2337/dc17-0374.

33. Tobar N, Oliveira AG, Guadagnini D, et al. Diacerhein improves glucose tolerance and insulin sensitivity in mice on a high-fat diet. Endocrinology, 2011, 152: 4080–4093.

34. Hotamisligil GS. Inflammation and metabolic disorders. Nature, 2006, 444: 860-7.

35. Du H, Shao J, Gu P, Lu B, Ye X, Liu Z. Improvement of glucose tolerance by rhein with restored early-phase insulin secretion in db/db mice. J Endocrinol Invest, 2012, 35: 607– 612.

36. Liu J, Chen Z, Zhang Y, et al. Rhein protects pancreatic b-cells from dynamin-related protein- 1-mediated mitochondrial fission and cell apoptosis under hyperglycemia. Diabetes, 2013, 62: 3927–393.

37. Malaguti C, Vilella CA, Vieira KP, Souza GH, Hyslop S, Zollner RdeL. Diacerhein downregu-late proinflammatory cytokines expression and decrease the autoimmune d iabetes frequency in nonobese diabetic (NOD) mice. Int Immunopharmacol, 2008, 8: 782–791.

38. Li H, George DM, Jaarsma RL, Mao X. Metabolic syndrome and components exacerbate osteoarthritis symptoms of pain, depression and reduced knee function. Ann Transl Med, 2016 Apr, 4(7): 133. doi: 10.21037/atm.2016.03.48.

39. Tootsi K, Mаrtson A, Kals J, Paapstel K, Zilmer M. Metabolic factors and oxidative stress in osteoarthritis: a case-control study. Scand J Clin Lab Invest, 2017 Jul, 24: 1-7. doi: 10.1080/00365513.2017.1354255.

40. Yasuda E, Nakamura R, Matsugi R, Goto S, Ikenaga Y, Kuroda K, Nakamura S, Katsuki Y, Katsuki T. Association between the severity of symptomatic knee osteoarthritis and cumulative metabolic factors. Aging Clin Exp Res, 2017 Jul 31. doi: 10.1007/s40520-017-0808-6.

41. Jatwa R, Kar А. Anti-inflammatory and anti-per-oxidative roles of diacerein are possibly mediated through an alteration in thyroid functions in animal model of inflammation. Fundamental & Clinical Pharmacology, 2009 Jun, 23(4): 465–471.

42. Sheng X, Wang M, Lu M, Xi B, Sheng H, Zang YQ. Rhein ameliorates fatty liver disease through negative energy balance, hepatic lipogenic regulation, and immunomodulation in diet-induced obese mice. Am J Physiol Endocrinol Metab, 2011, 300: 886–893.

43. Lin YJ, Hu G, Li KJ, Zhao YF, Wei J, Zhen YZ. The protection of rhein lysinate to liver in diabetic mice induced by high-fat diet and streptozotocin. Arch Pharm Res, 2015, 38: 885–892.

44. Guo MZ, Li XS, Xu HR, Mei ZC, Shen W, and Ye XF. Rhein inhibits liver fibrosis induced by carbon tetrac hloride in rats. Acta Pharmacologica Sinica, 2002, 23(8): 739–744.


Review

For citations:


Alexeeva LI, Taskinа EA, Kashevarova NG, Sharapova EP, Anikin SG, Strebkova EA, Korotkova TA, Raskina TA, Zonova EV, Oteva EN, Dilbaryan AG. NEW OPPORTUNITIES THERAPY IN PATIENTS WITH KNEE JOINT OSTEOARTHRITIS AND METABOLIC SYNDROME. Meditsinskiy sovet = Medical Council. 2018;(1):86-96. (In Russ.) https://doi.org/10.21518/2079-701X-2018-1-86-96

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