Disease-modifying treatment of osteoarthritis in current recommendations: lessons of the past and opportunities for the future

I.Yu. Golovach

Abstract


The modern views on the treatment of osteoarthritis from the perspective of structural-modifying therapy are defined in the article. The latest recommendations on the non-surgical treatment of osteoarthritis are presented; their heterogeneity is indicated, and the causes of the conflicting position, especially in the use of symptom-modifying slow-acting drugs (SYSADOAs) (glucosamine sulfate, chondroitin sulfate and hyaluronic acid), are analyzed. Harmonization and coordination of the latest
EULAR, OARSI, ACR, ESCEO recommendations and creation of a single step-by-step algorithm will improve the effects and effectiveness of the osteoarthritis treatment and will be the key to the improvement of the disease management. The ESCEO algorithm for the treatment of osteoarthritis of the knee joints, updated in 2016, outlines the shared opinion of experts according to which the use of SYSADOAs should be considered a safer and more comprehensive approach to the treatment of osteoarthritis than the continuous use of paracetamol as the first step in the management of knee osteoarthritis. Modern paradigm changes in the treatment of osteoarthritis mostly involve the recognition of osteoarthritis as a complex heterogeneous disease with several phenotypes, each of which requires different approaches to the optimization of treatment. So, according to the latest studies, the inflammatory, traumatic, bone-mediated and cartilage-mediated phenotypes of osteoarthritis are distinguished. The main goal of attempts to distinguish phenotypic variants of the course of the disease is, first of all, the individualization of treatment, because pathogenetically different clinical phenotypes of the disease require different therapeutic strategies. Potentially, each phenotype needs and can be treated with target (well-targeted) action, which requires early stratification of patients by phenotypes and appropriate stratification of drugs for osteoarthritis. The list of failures, the lessons of past researches, the limited success of the clinical development of new agents for the effective treatment of osteoarthritis can be partially mitigated by optimistic research hypotheses, but the result of their application will depend on the correct selection of patients for testing and well-targeted use in patients with the corresponding phenotypes of the disease.


Keywords


osteoarthritis; treatment; disease-modifying therapy; symptom-modifying slow-acting drugs; phenotype of osteoarthritis; glucosamine sulfate; chondroitin sulfate; recommendations

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DOI: https://doi.org/10.22141/1608-1706.3.18.2017.105356

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