Opportunities for optimizing therapy in the metabolic phenotype of osteoarthritis
https://doi.org/10.21518/ms2025-117
Abstract
Osteoarthritis (OA) is an extremely heterogeneous disease. Identifying a specific disease phenotype will help the practitioner optimize approaches to diagnosis and treatment. The metabolic phenotype of OA is associated with the greatest polyand comorbidity, which will significantly limit the choice of a number of drugs often used in the treatment of this joint pathology. The presented clinical observation demonstrates the difficulties in the care of a patient with a combination of eleven somatic diseases at the same time, one of which was OA. Care tactics suggest, on the one hand, justified polypragmasy, on the other hand, low adherence to long–term use of a large number of drugs. The presence of many comorbid diseases, in particular coronary heart disease, and history of stroke, suggest a complete rejection of the use of nonsteroidal anti-inflammatory drugs (with the exception of local forms). Regular therapy with a bioactive extract from small marine fish in the last two years has made it possible to achieve clinical improvement and, probably, prevent radiographic progression of knee joint OA and delay joint replacement surgery.
About the Authors
I. B. Bashkova
Chuvash State University named after I.N. Ulyanov; Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary)
Russian Federation
Russian Federation
Inna B. Bashkova - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Hospital Therapy, Chuvash SU named after I.N. Ulyanov; Rheumatologist, Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary).
15, Moskovsky Ave., Cheboksary, Chuvash Republic, 428015; 33, Fedor Gladkov St., Cheboksary, Chuvash Republic, 428020
E. I. Busalaeva
Chuvash State University named after I.N. Ulyanov; Institute for Advanced Training of Doctors
Russian Federation
Russian Federation
Elena I. Busalaeva - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Hospital Therapy, Chuvash SU named after I.N. Ulyanov; Associate Professor of the Department of Therapy and Family Medicine, Institute for Advanced Training of Doctors.
15, Moskovsky Ave., Cheboksary, Chuvash Republic, 428015; 27, Mikhail Sespel St., Cheboksary, Chuvash Republic, 428018
References
1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. https://doi.org/10.1016/S0140-6736(19)32989-7.
2. Karateev DE. Modern trends of pathogenetic therapy of osteoarthritis. Effective Pharmacotherapy. 2023;19(9):38–46. (In Russ.) Available at: https://elibrary.ru/zrqudr.
3. Marcianò G, Vocca C, Rania V, Citraro R, De Sarro G, Gallelli L. Metalloproteases in Pain Generation and Persistence: A Possible Target? Biomolecules. 2023;13(2):268. https://doi.org/10.3390/biom13020268.
4. Yao Q, Wu X, Tao C, Gong W, Chen M, Qu M et al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8(1):56. https://doi.org/10.1038/s41392-023-01330-w.
5. Hu W, Chen Y, Dou C, Dong S. Microenvironment in subchondral bone: predominant regulator for the treatment of osteoarthritis. Ann Rheum Dis. 2021;80(4):413–422. https://doi.org/10.1136/annrheumdis-2020-218089.
6. Lacourt M, Gao C, Li A, Girard C, Beauchamp G, Henderson JE, Laverty S. Relationship between cartilage and subchondral bone lesions in repetitive impact trauma-induced equine osteoarthritis. Osteoarthritis Cartilage. 2012;20(6):572–583. https://doi.org/10.1016/j.joca.2012.02.004.
7. Ulivi V, Giannoni P, Gentili C, Cancedda R, Descalzi F. p38/NF-kB-dependent expression of COX-2 during differentiation and inflammatory response of chondrocytes. J Cell Biochem. 2008;104(4):1393–1406. https://doi.org/10.1002/jcb.21717.
8. Jung YK, Han MS, Park HR, Lee EJ, Jang JA, Kim GW et al. Calciumphosphate complex increased during subchondral bone remodeling affects earlystage osteoarthritis. Sci Rep. 2018;8(1):487. https://doi.org/10.1038/s41598-017-18946-y.
9. De Palma A, Nalesso G. WNT Signalling in Osteoarthritis and Its Pharmacological Targeting. Handb Exp Pharmacol. 2021;269:337–356. https://doi.org/10.1007/164_2021_525.
10. De Santis M, Di Matteo B, Chisari E, Cincinelli G, Angele P, Lattermann C et al. The Role of Wnt Pathway in the Pathogenesis of OA and Its Potential Therapeutic Implications in the Field of Regenerative Medicine. Biomed Res Int. 2018;2018:7402947. https://doi.org/10.1155/2018/7402947.
11. Scanzello CR. Role of low-grade inflammation in osteoarthritis. Curr Opin Rheumatol. 2017;29(1):79–85. https://doi.org/10.1097/BOR.0000000000000353.
12. Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017;19(1):18. https://doi.org/10.1186/s13075-017-1229-9.
13. Maglaviceanu A, Wu B, Kapoor M. Fibroblast-like synoviocytes: Role in synovial fibrosis associated with osteoarthritis. Wound Repair Regen. 2021;29(4):642–649. https://doi.org/10.1111/wrr.12939.
14. Oo WM, Little C, Duong V, Hunter DJ. The Development of Disease-Modifying Therapies for Osteoarthritis (DMOADs): The Evidence to Date. Drug Des Devel Ther. 2021;15:2921–2945. https://doi.org/10.2147/DDDT.S295224.
15. Dell’Isola A, Allan R, Smith SL, Marreiros SS, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016;17(1):425. https://doi.org/10.1186/s12891-016-1286-2.
16. Dell’Isola A, Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative. PLoS ONE. 2018;13(1):e0191045. https://doi.org/10.1371/journal.pone.0191045.
17. Caporali R, Cimmino MA, Sarzi-Puttini P, Scarpa R, Parazzini F, Zaninelli A et al. Comorbid conditions in the AMICA study patients: effects on the quality of life and drug prescriptions by general practitioners and specialists. Semin Arthritis Rheum. 2005;35(1 Suppl. 1):31–37. https://doi.org/10.1016/j.semarthrit.2005.02.004.
18. Alenazi AM, Alothman S, Alshehri MM, Rucker J, Waitman LR, Wick J et al. The prevalence of type 2 diabetes and associated risk factors with generalized osteoarthritis: a retrospective study using ICD codes for clinical data repository system. Clin Rheumatol. 2019;38(12):3539–3547. https://doi.org/10.1007/s10067-019-04712-0.
19. Strebkova EA, Alekseeva LI. Osteoarthritis and obesity. Rheumatology Science and Practice. 2015;53(5):542–552. (In Russ.) Available at: https://rsp.mediar-press.net/rsp/article/view/2131/1357.
20. Zhang Q, Zhao YX, Li LF, Fan QQ, Huang BB, Du HZ et al. MetabolismRelated Adipokines and Metabolic Diseases: Their Role in Osteoarthritis. J Inflamm Res. 2025;18:1207–1233. https://doi.org/10.2147/JIR.S499835.
21. Sampath SJP, Venkatesan V, Ghosh S, Kotikalapudi N. Obesity, Metabolic Syndrome, and Osteoarthritis – An Updated Review. Curr Obes Rep. 2023;12(3):308–331. https://doi.org/10.1007/s13679-023-00520-5.
22. Fan J, Zhu J, Sun L, Li Y, Wang T, Li Y. Causal association of adipokines with osteoarthritis: a Mendelian randomization study. Rheumatology. 2021;60(6):2808–2815. https://doi.org/10.1093/rheumatology/keaa719.
23. 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;20(11):1217–1226. https://doi.org/10.1016/j.joca.2012.06.006.
24. Berenbaum F. Diabetes-induced osteoarthritis: from a new paradigm to a new phenotype. Postgrad Med J. 2012;88(1038):240–242. https://doi.org/10.1136/pgmj.2010.146399rep.
25. Ching K, Houard X, Berenbaum F, Wen C. Hypertension meets osteoarthritis – revisiting the vascular aetiology hypothesis. Nat Rev Rheumatol. 2021;17(9):533–549. https://doi.org/10.1038/s41584-021-00650-x.
26. Xiong J, Long J, Chen X, Li Y, Song H. Dyslipidemia Might Be Associated with an Increased Risk of Osteoarthritis. Biomed Res Int. 2020;2020:3105248. https://doi.org/10.1155/2020/3105248.
27. Karateev AE, Nasonov EL, Ivashkin VT, Martynov AI, Yakhno NN, Arutyunov GP et al. Rational use of nonsteroidal anti-inflammatory drugs. Clinical guidelines. Rheumatology Science and Practice. 2018;56(Suppl. 1):1–29. (In Russ.) Available at: https://rsp.mediar-press.net/rsp/article/view/2536.
28. Alekseeva LI, Lila AM. Osteoarthritis background therapy: current view on the glucosamine and chondroitin therapy. Sovremennaya Revmatologiya. 2021;15(2): 112–119. (In Russ.) https://doi.org/10.14412/1996-7012-2021-2-112-119.
29. Lila AM, Alekseeva LI, Babaeva AR, Gaydukova IZ, Gandolini G, Zonova EV et al. Pharmacological treatment options for osteoarthritis: focus on symptomatic slow-acting drugs for osteoarthritis (SYSADOA) and individual patient characteristics: Resolution of the International Expert Meeting. Sovremennaya Revmatologiya. 2019;13(4):143–147. (In Russ.) https://doi.org/10.14412/1996-7012-2019-4-143-147.
30. Tsurko VV, Zamyatina EA, Bagrova GG. Osteoarthritis: management of patients and compliaence to treatment Meditsinskiy Sovet. 2017;(20):134–137. (In Russ.) https://doi.org/10.21518/2079-701X-2017-20-134-137.
31. Feklistov AYu, Vorobieva LD, Alekseeva OG, Sukhinina AV, Andrianova IA, Menshikova IV et al. Post hoc analysis of the results of KOLIBRI comparative observational clinical study in patients with knee and small hand joints osteoarthritis. Sovremennaya Revmatologiya. 2022;16(6):64–72. (In Russ.) https://doi.org/10.14412/1996-7012-2022-6-64-72.
32. Danilov AB, Lila AM, Feklistov AYu. Two views on the problem of osteoarthritis and osteochondrosis: comparison of approaches to the therapy (post-release). RMJ. 2021;29(7):74–78. (In Russ.) Available at: https://www.rmj.ru/articles/revmatologiya/Dva_vzglyada_naproblemu_osteoartrita_iosteohondroza_sravnenie_podhodov_kterapii_postreliz/
33. Ktsoyeva AA, Totrov IN, Tebloev MM, Kupeeva AM, Kusova AB, Albegova ZA et al. Cartilaginous glycoprotein-39 as laboratory marker of dynamics of course and effectiveness of treatment in patients with osteoarthritis. Medical Alphabet. 2023;(9):57–63. (In Russ.) https://doi.org/10.33667/2078-5631-2023-9-57-63.
34. Khanov AG. Experience in the use of a modern chondroprotector in patients with primary and secondary osteoarthritis of various localization in the acute stage. Lechaschi Vrach. 2023;26(5):29–35. (In Russ.) https://doi.org/10.51793/OS.2023.26.5.005.
Review
For citations:
Bashkova IB, Busalaeva EI. Opportunities for optimizing therapy in the metabolic phenotype of osteoarthritis. Meditsinskiy sovet = Medical Council. 2025;(3):134-143. (In Russ.) https://doi.org/10.21518/ms2025-117
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