Просмотр полной версии : остеоартроз

Существует ли опыт применения американской БАД "Kirkland signature:
Glucosamin HCL 500 mg, Hondroitin sulfate 400 mg ? Трижды в день по 1
таблетке в течение 5-6 месяцев. Кто и что знает об этом?

Взгляните на эти публикации: может также нужно добавить аскорбата марганца для большей эффективности?

Cranio 2001 Apr;19(2):130-9
A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study.
Nguyen P, Mohamed SE, Gardiner D, Salinas T.
Louisiana State University Health Sciences Center, New Orleans, USA.
Previous studies have shown chondroitin sulfate and glucosamine hydrochloride have beneficial effects on symptoms of osteoarthritis of the knee. Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate (CS) taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Forty-five subjects were enrolled in the study and were randomly assigned to either an active medication group or a placebo group. Eleven subjects were lost from the study for various reasons, resulting in fourteen subjects remaining in the active medication group and twenty subjects remaining in the placebo group. Subjects taking CS-GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily over-the-counter medications needed. Subjects taking the placebo medication had improvements in their pains as measured by the visual analog scale and by four indices of the McGill Pain Questionnaire. Additional studies are required to evaluate the clinical effectiveness of CS-GH and to determine the exact mechanism by which CS-GH affects the articular cartilage of synovial joints.

Osteoarthritis Cartilage 2000 Sep;8(5):343-50
Efficacy of a combination of FCHG49 glucosamine hydrochloride, TRH122 low molecular weight sodium chondroitin sulfate and manganese ascorbate in the management of knee osteoarthritis.
Das A Jr, Hammad TA.
Hendersonville Orthopedics Associates, Hendersonville, North Carolina 28739, USA.
OBJECTIVES: The objective of this study was to evaluate the oral combination of glucosamine HCl, sodium chondroitin sulfate and manganese ascorbate for the treatment of osteoarthritis (OA) of the knee. DESIGN: A randomized placebo-controlled study design was implemented. We recruited 93 patients with OA of the knee from a single center. The intervention group received 1000 mg FCHG49 glucosamine HCl, 800 mg TRH122 low molecular weight sodium chondroitin sulfate and 152 mg manganese ascorbate twice daily (Cosamin DS). Patients were evaluated initially and then every 2 months for 6 months. The primary outcome was the Lesquene Index of severity of osteoarthritis of the knee (ISK). RESULTS: Patients with radiographically mild or moderate OA (N=72) in the intervention group showed significant improvement in the ISK at 4 and 6 months (P=0.003 and P=0.04, respectively). The response rate to the medication was 52% vs a 28% response rate to placebo. Patients with radiographically severe osteoarthritis (N=21) did not show significant improvements in the ISK. There was a 17% incidence of adverse events in the intervention group and 19% in the placebo group. CONCLUSIONS: The studied combination of glucosamine HCl, sodium chondroitin sulfate and manganese ascorbate was found to be effective for the treatment of radiographically mild to moderate OA of the knee as measured by the ISK.

Mil Med 1999 Feb;164(2):85-91
Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study.
Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD.
Medical Department, Naval Special Warfare Group Two, Naval Amphibious Base Little Creek, Norfolk, VA 23521, USA. [Ссылки могут видеть только зарегистрированные и активированные пользователи]
OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted. METHODS: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score. RESULTS: Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects. CONCLUSIONS: The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.

Если вопрос носит не научный характер, а касается практического применения, то обострение артроза(это о консервативном лечении) лечится комплексно.
Во-первых разгрузка сустава, во-вторых медикаментозная терапия, включающая прежде всего нестероидные противовоспалительные препараты и вазоактивные препараты(трентал, флекситал), в-третьих физиотерапевтическое лечение. Препараты глюкуроновой кислоты применяют для закрепления эффекта противовоспалительного лечения, и вводят как паралельно основному лечению, так и после него.
На мой взгляд отечественный препарат мукосат намного дешевле БАД, к тому же, он вводится парэнтерально один раз в сутки или через сутки.

Вазоактивные препараты (трентал, флекситал)??

При остеоартрозе?

:confused:

Не слышал. Пожалуйста, укажите на литературные источники.

Этот чудо-препарат в отечестве считается лекарством от всех болезней...

Valeriy, зря вы так о Трентале.
При остеоартрозе - и мне сомнительно, но как вазоактивный - даже Кокрейн согласен. ;)

Оптимальным показанием для назначения пентоксифиллина при ОА может стать относительно высокий уровень ФНО, несмотря на назначение НПВС. Как это определить клинически? Весьма затруднительно, может быть по повышенному ЦРБ или ускоренному СОЭ, или же относительной анальгетической неэффективности НПВС, по аналогии с РА и др. коллагенозами.

Выяснялась ли возможная связь между приемом высоких доз хондропротекторов и вазодепрессивными реакциями?

Раз уж ввязался...
Есть ли где-то данные об успешном клиническом применении пентоксифиллина в зависимости от уровня TNF? Рекомендации доз, ингибирующих TNF? Буду благодарен за источник. Не обязательно в связи с остеоартритом.

Уважаемый Валерий!
Пожалуйста (если что-то будет интересно почитать в оригинале, вышлю пдф-ом на мейл):

Am J Cardiol. 2002 Nov 15;90(10):1118-22.
Effects of pentoxifylline on cytokine profiles and left ventricular performance in patients with decompensated congestive heart failure secondary to idiopathic dilated cardiomyopathy.

Sliwa K, Woodiwiss A, Candy G, Badenhorst D, Libhaber C, Norton G, Skudicky D, Sareli P.

Heart Failure Research Unit, Department of Cardiology, Chris-Hani Baragwanath Hospital, University of the Witwatersrand, P.O. Bertsham, 2013 Johannesburg, South Africa. [Ссылки могут видеть только зарегистрированные и активированные пользователи]

Patients with severe heart failure have plasma cytokine concentrations that are more than twofold greater than those in patients with moderate heart failure. Although pentoxifylline, an immunomodulatory agent that inhibits tumour necrosis factor-alpha (TNF-alpha) production, improves pump function in mild-to-moderate heart failure, its effects on advanced heart failure have not been determined. In a prospective, randomized, double-blind, placebo-controlled study we compared the effects of 1-month therapy with pentoxifylline (400 mg 3 times daily) (n = 9) and placebo (n = 9) on left ventricular systolic function and dimensions as well as on plasma TNF-alpha (picograms per milliliter), interleukin-10 (IL-10), and the apoptosis-signaling receptor Fas/Apo-1 in patients with idiopathic dilated cardiomyopathy and advanced heart failure. All patients had New York Heart Association functional class IV heart failure, required intravenous inotropic agents for >72 hours at the beginning of the study, and received diuretics, digoxin, and an angiotensin-converting enzyme inhibitor for the duration of the study. Marked increases in TNF-alpha and Fas/Apo-1 concentrations were noted in the 18 patients compared with patients with functional class II to III heart failure and controls (p <0.001). Baseline characteristics were the same between the pentoxifylline and placebo groups. Pentoxifylline administration resulted in reduced TNF-alpha and Fas/Apo-1 concentrations, and an increase in ejection fraction at 1 month (p <0.05 compared with baseline and with placebo), effects that were not observed in the placebo-treated group. These data suggest that pentoxifylline may be a useful adjunct to conventional therapy in patients with severe heart failure.

Eur J Heart Fail. 2002 Jun;4(3):305-9.
The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy.

Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P.

Department of Cardiology, Baragwanath Hospital, University of the Witwatersrand, PO Bertsham 2013, Johannesburg, South Africa. [Ссылки могут видеть только зарегистрированные и активированные пользователи]

We have reported previously that despite treatment with angiotensin-converting enzyme inhibitors and beta blockers, the outcome of patients with peripartum cardiomyopathy (PPC) remains unfavorable. Similar to other etiologies of left ventricular dysfunction, we found elevated levels of tumor necrosis factor-alpha (TNF-alpha) in this group of patients. In the present study we sought to evaluate the effects of pentoxifylline, a drug known to inhibit the production of TNF-alpha, on clinical status, left ventricular function, and circulating plasma levels of TNF-alpha, in patients with PPC. We followed prospectively 59 consecutive women with PPC. The first 29 patients (group 1) were treated with diuretics, digoxin, enalapril and carvedilol. The next 30 consecutive patients (group 2) received pentoxifylline 400 mg TID in addition to the previous therapy. Clinical evaluation, echocardiograms and TNF-alpha determinations were performed at baseline and after 6 months of treatment. Patients in the pentoxifylline group were older and had a higher E/A ratio. Nine patients died (eight in group 1, P = 0.009 between groups). A combined end-point of poor outcome defined as either death, failure to improve the left ventricular ejection fraction >10 absolute points or functional class III or IV at latest follow-up, occurred in 52% of patients in group 1 and 27% of patients in group 2 (P = 0.03). Treatment with pentoxifylline (P = 0.04) was the only independent predictor of outcome. In conclusion, the results of this study suggest that the addition of pentoxifylline to conventional treatment, improves outcome in patients with peripartum cardiomyopathy.

Nephrol Dial Transplant. 2001 Jul;16(7):1524-5.

Renal failure, anaemia, cytokines and inflammation.

Mora C, Macia M, Navarro JF.

We performed a study to analyse the effects of pentoxifylline administration, a pharmacologic agent with anti-TNF- properties, on haematologic parameters and the serum levels of this cytokine in anaemic patients with advanced renal failure. We studied 12 diabetic patients with a creatinine clearance below 30 ml/min. There was no clinical evidence of blood loss, infection or neoplastic disease. The iron status was normal in all cases, defined as a serum ferritin and a transferrin saturation higher than 50 ng/ml and 20%, respectively. None were under treatment with angiotensin-converting enzyme inhibitors, androgens, Epo or theophylline preparations. Seven patients received pentoxifylline (400 mg orally daily) for 6 months, and the evolution was compared with those observed in five control patients. During the study, haemoglobin and haematocrit progressively increased in subjects receiving pentoxifylline, from 9.9±0.5 g/dl and 27.9±1.6% at baseline to 10.6±0.6 g/dl and 31.3±1.9% after 6 months, respectively (P<0.01). Conversely, no significant variations were observed in these parameters in the control group. Serum TNF-, levels exhibited a significant decrease with respect to basal values in patients treated with pentoxifylline (562±358 vs 623±366 pg/ml, P<0.01), but not in controls.

Gastroenterology. 2000 Dec;119(6):1637-48.
Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.

Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O.

Liver Unit, University of Southern California, Rancho Los Amigos Medical Center, Downey, California.

BACKGROUND & AIMS: An earlier pilot study from our liver unit suggested benefit from treatment with pentoxifylline (PTX), an inhibitor of tumor necrosis factor (TNF), in severe acute alcoholic hepatitis. The aim of the present study was to evaluate this treatment in a larger cohort of patients. METHODS: One hundred one patients with severe alcoholic hepatitis (Maddrey discriminant factor > or = 32) entered a 4-week double-blind randomized trial of PTX (400 mg orally 3 times daily) vs. placebo. Primary endpoints of the study were the effect of PTX on (1) short-term survival and (2) progression to hepatorenal syndrome. On randomization, there were no differences in demographic and clinical characteristics or laboratory values (including TNF) between the 2 groups. RESULTS: Twelve (24.5%) of the 49 patients who received PTX and 24 (46.1%) of the 52 patients who received placebo died during the index hospitalization (P = 0.037; relative risk, 0.59; 95% confidence interval, 0.35-0.97). Hepatorenal syndrome was the cause of death in 6 (50%) and 22 (91.7%) patients (P = 0.009; relative risk, 0.29; 95% confidence interval, 0.13-0.65). Three variables (age, creatinine level on randomization, and treatment with PTX) were independently associated with survival. TNF values on randomization were not predictive of survival; however, during the study period they increased markedly in nonsurvivors compared with survivors in both groups. CONCLUSIONS: Treatment with PTX improves short-term survival in patients with severe alcoholic hepatitis. The benefit appears to be related to a significant decrease in the risk of developing hepatorenal syndrome. Increasing TNF levels during the hospital course are associated with an increase in mortality rate.

Am J Kidney Dis. 1999 Mar;33(3):458-63.
Urinary protein excretion and serum tumor necrosis factor in diabetic patients with advanced renal failure: effects of pentoxifylline administration.

Navarro JF, Mora C, Rivero A, Gallego E, Chahin J, Macia M, Mendez ML, Garcia J.

Department of Nephrology, Hospital Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain. [Ссылки могут видеть только зарегистрированные и активированные пользователи]

In 24 diabetic patients with advanced renal failure (creatinine clearance [C(Cr)] < 35 mL/min), we prospectively studied serum tumor necrosis factor-alpha (TNF-alpha) levels, the possible relationship with urinary protein excretion, and the effects of pentoxifylline (PTF) administration. PTF (400 mg daily) was administered for 6 months to 14 patients, and the results were compared with data from a control group (n = 10). Baseline parameters were similar in both groups. At the end of the study, urinary protein excretion and serum TNF-alpha decreased in the active group from 2.7 (1.2 to 5.8) g/d and 569 +/- 285 pg/mL to 1.1 (0.3 to 4.0) g/d and 329 +/- 232 pg/mL, respectively (P < 0.001). By contrast, proteinuria and TNF-alpha did not change in the control group. Regression analysis showed a significant correlation between proteinuria and serum TNF-alpha both at basal (r = 0.55) and at the sixth month (r = 0.57). Furthermore, the reduction of urinary protein excretion was strongly correlated with the decrease of TNF-alpha (r = 0.72, P < 0.01). Serum Cr and C(Cr) remained stable in both groups during the study. Our findings suggest that cytokines might play a role in renal damage in diabetic nephropathy. PTF is effective in reducing proteinuria in diabetic patients with advanced renal failure. The anticytokine activity of PTF may be a further explanation for this antiproteinuric effect.

J Interferon Cytokine Res. 1998 Oct;18(10):871-7.
Tumor necrosis factor-alpha levels decrease with anticytokine therapy in patients with myelodysplastic syndromes.

Reza S, Shetty V, Dar S, Qawi H, Raza A.

Rush Cancer Institute, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612-3515, USA.

Tumor necrosis factor-alpha (TNF-alpha) levels were measured in the serum (sTNF-alpha) or bone marrow (BM) biopsies of 43 patients with myelodysplastic syndromes (MDS) who subsequently received therapy with a combination of pentoxifylline and ciprofloxacin (PC) with or without dexamethasone (PCD) [pentoxifylline 800 mg 3 times a day and ciprofloxacin 500 mg twice a day by mouth; dexamethasone was added to the regimen for the partial responders and the nonresponders after 12 weeks at a dose of 4 mg by mouth every morning for 4 weeks]. All 43 patients received only PC therapy for 12 weeks, after which 18 of 36 nonresponders received PCD. A total of 18 of 43 patients showed a hematologic or cytogenetic response or both. BM TNF-alpha levels were semiquantitatively assessed using immunohistochemistry on a scale of 0-8+ and in the serum using enzyme linked immunoassay. The median TNF-alpha for the entire group was 3.0 in BM and 6.9 pg/ml in the serum, and 14 patients had no detectable levels. Responders had higher BM levels (median 3.5 vs. 2.0) than nonresponders, although this was not statistically significant. During PC therapy, a decline in BM TNF-alpha level was seen in the entire group, which was significant at 2 weeks (p = 0.02), 8 weeks (p = 0.001), and 12 weeks (p = 0.0001). Both responders (p = 0.01) and nonresponders (p = 0.03) had a decline at 8 weeks, but at 12 weeks, only the responders continued to show a significant decline (p = 0.03). We conclude that MDS patients with high BM TNF-alpa levels have a better chance of responding to PCD therapy and that the therapy is quite successful in reducing the TNF-alpha levels in a sustained fashion. Future studies need to be directed at identifying agents that would be more potent suppressors of the proapoptotic cytokines in these patients.

Rev Rhum Engl Ed. 1997 Dec;64(12):789-93.
An open study of the anti-TNF alpha agent pentoxifylline in the treatment of rheumatoid arthritis.

Dubost JJ, Soubrier M, Ristori JM, Beaujon G, Oualid T, Bussiere JL, Sauvezie B.

Clinical Immunology Unit, Gabriel-Montpied Hospital, Clermont-Ferrand, France.

OBJECTIVE: Monoclonal antibodies to TNF alpha have a rapid therapeutic effect in rheumatoid arthritis. Pentoxifylline is an anti-TNF alpha agent that is easier to handle than antibodies. METHODS: An open prospective trial was conducted in 21 patients with active rheumatoid arthritis. Pentoxifylline was given in a daily dosage of 1,200 mg for at least one month. Five patients received the drug as a continuous intravenous infusion during the first seven days. RESULTS: After one month, a significant decrease in the pain severity score was noted, but all other clinical and laboratory efficacy parameters were unchanged. A limited response was seen in four patients. TNF alpha levels did not decrease under therapy. CONCLUSION: Under the conditions of our trial, the therapeutic benefits provided by pentoxifylline were too small to warrant use of this drug in severe refractory rheumatoid arthritis.

Большое спасибо, уважаемый Dr. Vad.
Подождем немного, может, дождемся и широкого клинического применения. (Пока что методика применения пентоксифиллина в наших отечествах явно не строится на данных исследованиях. Хотя есть таблетки по 400 мг.) Окончательные выводы еще впереди. Но заманчиво...