Glukozamin sulfat u lečenju osteoartroze kolena

Abstract

Cilj ove disertacije je bio da se ispita i utvrdi simptomatski i strukturalni efekat primene kristalnog glukozamin sulfata (KGS) (1.5 g/dan) kod osteoartroze kolena. Primena KGS je upoređivana u odnosu na nesteroidne antiinflamatorne lekove (NSAIL) (ibuprofen 1200-1600 mg/dan; diklofenak natrijum 75mg/dan). U otvorenu, prospektivnu studiju sa periodom praćenja od godinu dana, je uključeno 111 ambulatnih bolesnika oba pola, starosti ≥55 godina. Istraživanje je sprovedeno u Specijalnoj bolnici za reumatske bolesti u Novom Sadu u periodu od 2011.-2013. godine. Do kraja je u studiji ostalo 80 bolesnika. Bolesnici su dolazili na zakazane kontrole nakon 1.,3.,6.,9. i 12. meseca (5 kontrola). Procena terapijskog efekta je praćena pomoću kliničkih (WOMAC index i Lequesne index) i strukturalnih parametara bolesti (radiološko merenje širine zglobnog prostora u medijalnom kompartmanu tibiofemoralanog zgloba kolena). Nakon 1. meseca kod bolesnika NSAIL grupe je registrovano statistički značajnije smanjenje bola i ukočenosti i poboljšanje funkcije (p<0.05). Za isti period obe grupe bolesnika su imale niži Lequesne indeks, bez statistički značajne razlike (p>0.05). Nakon 3. meseca kod bolesnika KGS grupe i bolesnika NSAIL je registrovano ublažavanje simptoma bolesti, bez statistički značajne razlike (p>0.05). Nakon 6. meseca, primena KGS je dovela do značajnijeg smanjenja bola, poboljšanja funkcije zgloba i smanjenja Lequesne indeksa (p<0.01). Daljom primenom KGS nastavljen je trend smanjenja simptoma bolesti. Na kraju istraživanja bolesnici KGS grupe su imali statistički značajnije smanjenje bola, poboljšanje funkcije (WOMAC bol, WOMAC funkcionalni status i ukupan WOMAC zbira) (p<0.01) i poboljšanje simptoma praćenih pomoću Lequene indeksa u odnosu na bolesnike NSAIL grupe (p>0.05). U periodu prekida uzimanja KGS (početak 7. do kraja 9. meseca) kod bolesnika je registrovano pogoršanje simptoma bolesti u odnosu na prethodnu kotrolu, ali je tokom 1. meseca prekida uzimanja KGS (7. mesec istraživanja) održavan prolongirani simptomatski efekat leka, jer nije zabeleženo uzimanje tbl. acetamonofena. U obe grupe bolesnika je registrovano radiološko napredovanje bolesti, odnosno smanjenje širine zglobnog prostora kolena bez statistički značajne razlike među grupama (p>0.05). Simptomatska efikasnost je pokazana primenom KGS i NSAIL, s tim što je progresivnije poboljšanje simptoma bolesti nastupilo u KGS grupi, dok se u NSAIL grupi trend poboljšanja gubio i to pokazuje da KGS ima prolongirane simptomatske efekte, iako njegova strukturna efikasnost nije dokazana.

Abstract The aim of this thesis was to research and ablish symptomatic and struc - tural effect of crystalline glucosamine sulfate (CGS) (1.5 g/day) in knee osteoarthrosis. CGS treatment was compared to nonsteroid anti-inflammatory drugs (NSAID) (ibuprofen 1200- 1600 mg/day; diclofenac sodium 75 mg/day). The open, prospective studyStudy was carried out in the Special hospital for rheumatic diseases in Novi Sad, during 2011-2013 period with one year fol- low-up included 111 outpatients of both genders, 55 years of age or morEighty patients had completed the study. Every patient had checkups scheduled after 1, 3, 6, 9and 12 months (5 checkups total). Assessment of therapy effect has been done using clinical (WOMAC index and Lequesne index) and structural parameters of the disease (radiologic measurements of joint space width at the medial compartment in tibiofemoral knee joint) .Af- ter one month, a statistically significant reduction of pain and stiffness with improvement of joint function (p<0.05) was noted in patients from NSAID group. In this period, both groups had lower Lequesne index, without statistical significance (p>0.05). After 3 months, in both groups (CGS and NSAID patients), symptoms improvement was noted without statistically significant differences (p>0.05). After 6 months, CGS brought significant pain reduction im -provement of joint function and decrease in Lequesne index (p<0.01). Further treatment by CGS continued to reduce symptoms of the disease. At the end of trial, patients from CGS group had statistically more significant pain reduction, function improvement (WOMAC pain, WOMAC functional status and total WOMAC score) (p<0.01) and symptoms improve- ments measured by Lequesne index in comparison to patients from NSAID group (p>0.05). In the period of pause in CGS treatment (months 7 to 9), worsening of symptoms has been noted in patients in comparison to previous checkup, but during the first month of pause (sev- enth month of trial) prolonged symptomatic effect of the drug had been maintained, since pa- tients did not report taking acetaminophen tablets. In both groups of patients, radiological progression of disease was noted, i.e. joint space narrowing at the knee, without statistically significant differences between the groups (p>0.05). The symptomatic effect hadof using both CGS and NSAID, but CGS group had shown more progressive improvement of symptoms, while in NSAID group improvement trend had faded away, and that's why we could conclude that CGS had prolonged symptomatic effects, although its structural efficacy had not been proven.