In the treatment of joint inflammatory and degenerative-dystrophic pathologies, drugs of various clinical and pharmacological groups are used. But most of them are designed to eliminate symptoms – joint pain, swelling, stiffness. And chondroprotectors are used to treat joint diseases with the aim of partial restoration of damaged hyaline cartilage, strengthening the ligament-tendon apparatus.
- How chondroprotectors work
- Performance Details
- Classification of drugs
- Indications for use
- For arthritis and rheumatoid arthritis
- With a hernia of the spinal disc
- With cervical osteochondrosis
- With osteoarthritis
- With arthrosis of the knee joint (gonarthrosis)
- With coxarthrosis
- What form of drugs is most effective
- List of effective drugs
- Chondroitin sulfate
- How to choose the right tool
- For adults
- For pregnant and breastfeeding
- For children
- Side effects
How chondroprotectors work
In the treatment of joints, drugs with the active ingredients in chondroitin sulfate, glucosamine sulfate or hydrochloride are most in demand. Chondroprotectors also include hyaluronic acid, which is found in the synovial fluid, and collagen, the structural unit of ligaments and tendons. Glucosamine in the human body serves as a precursor of chondroitin, therefore, similar therapeutic properties are characteristic of these organic compounds. After penetration into the patient’s body, glucosamine and chondroitin exhibit the following pharmacological activity:
- stimulate the synthesis of proteoglycans – the main components of the intercellular substance;
- accelerate the production of high molecular weight hyaluronic acid by synoviocytes;
- inhibit the activity of metalloproteinase enzymes that damage connective tissue structures;
- activate all the functions of chondrocytes (the main cells of cartilage tissue);
- inhibit premature destruction of chondrocytes;
- inhibit enzymes that stimulate the biosynthesis of inflammatory mediators;
- improve microcirculation in the subchondral bone and synovial membranes.
After the accumulation of chondroitin or glucosamine in the joint cavity, they exhibit pronounced analgesic and anti-inflammatory effects. This is due to the ability of chondroprotectors to inhibit the activity of lysosomal enzymes and superoxide radicals, to inhibit the production of cytokines, prostaglandins.
To study the structurally modifying effect of glucosamine and chondroitin, lengthy double-blind, placebo-controlled studies were conducted. Volunteers with osteoarthritis of the knee joint, a severe degenerative-dystrophic pathology, took part in the tests. And the main evaluation criterion for the therapeutic effectiveness of chondroprotectors was a change in the size of the joint space. Patients took chondroitin at a dose of 0,8 g per day for two years. As a result, the stabilizing effect of chondroprotectors on the size of the joint space was found.
Course administration of glucosamine and (or) chondroitin not only prevents the spread of joint pathologies to healthy tissues, but also improves the well-being of patients:
- reduces the severity of pain, including through the relief of inflammatory processes;
- increases the range of motion in the joints;
- eliminates edema, compressing the sensitive nerve endings;
- relieves of crunch, clicks, cod when walking, bending or flexing joints.
Rovetta et al published the results of studies of the action of chondroprotectors in osteoarthritis of the joints of the hands. A daily intake of chondroitin for 2 years has prevented the formation of new erosion.
With chondroprotectors for local application to damaged joints, it is not so simple. The therapeutic effectiveness of ointments, gels, creams was not confirmed by any tests or their results were unreliable. Therefore, experienced rheumatologists, neurologists, orthopedists prefer to prescribe only systemic chondroprotectors to patients.
Classification of drugs
Chondroprotectors are classified according to the active ingredients. It is the pharmacological properties of the main components that determine the therapeutic effect of the drugs. The composition of chondroprotectors is always taken into account by a doctor when prescribing their patients with a particular joint disease. In pathologies of 1 or 2 severity, a single-component drug is usually sufficient. And with rapidly progressing arthritis or arthrosis, combined drugs with chondroitin and glucosamine are included in therapeutic regimens.
|The group of chondroprotectors used in the treatment of articular pathologies||Name of medicines|
|Preparations with ingredients of animal or vegetable origin||Alflutop, Rumalon, Piaskledin|
|Means with the active substance chondroitin sulfate||Chondroxide, Chondrolone, Mucosate, Structum, Chondroitin-Akos|
|Preparations with the active ingredient glucosamine sulfate or hydrochloride||Arthron Flex, Dona|
|Means with a combined composition||Teraflex, Arthra, Formula-C, Glucosamine-Chondroitin Complex|
|Preparations with mucopolysaccharides||Arteparon|
Indications for use
Chondroprotectors are used in the treatment of inflammatory joint pathologies – reactive, rheumatoid, gouty or psoriatic arthritis. They are included in the treatment regimens of patients with bursitis, synovitis, tendonitis, tendovaginitis, epicondylitis, shoulder-shoulder periarthritis. The use of chondroprotectors allows you to accelerate the restoration of joints after fractures, dislocations, ruptures of ligaments, muscles, and tendons. They are prescribed to weakened patients to reduce the doses of systemic drugs and reduce the pharmacological load on the body.
But the main range of application of chondroprotectors is the treatment of degenerative-dystrophic articular pathologies.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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For arthritis and rheumatoid arthritis
In the treatment of arthritis, chondroprotectors are used as supplements. The main treatment is carried out with non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, and with infectious pathologies – with antibiotics. Preparations with chondroprotective properties are used during the rehabilitation period to restore joint structures that have been damaged by the inflammatory process.
Rheumatoid arthritis develops due to aggression of the immune system aimed at the body’s own cells. Drugs with glucosamine and chondroitin, in contrast to NSAIDs, are well combined with immunosuppressive drugs.
With a hernia of the spinal disc
Intervertebral hernia – protrusion of the intervertebral disc between the vertebral bodies. This is one of the serious complications of cervical, thoracic, lumbosacral osteochondrosis. Hernias are formed in pathologies of 2-3 severity, which are characterized by irreversible damage to the cartilage tissue of the intervertebral discs. Therefore, even prolonged use of chondroprotectors does not regenerate destroyed tissue.
It is advisable to use these drugs in the treatment of hernias to reduce doses of NSAIDs, glucocorticosteroids, which have a toxic effect on bones, cartilage, and internal organs.
With cervical osteochondrosis
Long-term use of chondroprotectors is very effective in the initial stages of development of osteochondrosis of any localization. At this stage of the disease, the intervertebral discs have not yet undergone significant destruction, therefore, there is a high probability of their partial regeneration, as well as an improvement in the condition of ligaments, muscle fibers. Medicines stimulate the strengthening of the ligament-tendon apparatus, prevent the deformation of bone structures, the formation of osteophytes.
With cervical osteochondrosis of a high degree of severity, the use of chondroprotectors to restore cartilage tissue is useless. In this case, they are prescribed only to slow down the destructive degenerative process.
Gout is a rheumatic pathology caused by the deposition of crystals of uric acid salts – urates – in the joints, then in the kidneys. Due to the constant irritation of the soft tissues, an inflammatory process develops, and the cartilage and bones are gradually destroyed. Chondroprotectors are often prescribed to patients with this pathology. They have a complex effect – they prevent damage to connective tissue structures, and with constant use they stop inflammation and eliminate soreness.
It is advisable to use medicines daily, and not during a gouty attack. This mode allows you to reduce the severity of symptoms, to prevent the appearance of new attacks.
At the initial stage of deforming osteoarthrosis, chondroprotectors with glucosamine hydrochloride and chondroitin sulfate are effective. Combined drugs, for example, Teraflex, help to stop further destruction of the cartilage and restore its structure. With osteoarthritis at the 3-4th radiological stage, irreversible damage occurred, so tissue regeneration is impossible.
This disease has not yet been completely cured. His therapy is aimed at stopping the destruction processes, eliminating joint deformation. System chondroprotectors successfully cope with these tasks, but only with their long-term (up to 2 years) continuous use.
With arthrosis of the knee joint (gonarthrosis)
Gonarthrosis is a degenerative-dystrophic pathology in which the hyaline cartilage that covers the condyles of the tibia and femur is affected. If the disease is diagnosed at the initial stage, then chondroprotectors are necessarily included in the therapeutic regimen. Treatment begins with the introduction of injection solutions, and then the result is fixed by the course of taking tablets or capsules.
In case of gonarthrosis of 2 severity, chondroprotectors are prescribed as prophylaxis of the spread of the destructive process and lower doses of NSAIDs, glucocorticosteroids. Pathology at stage 3 is not amenable to conservative therapy – knee replacement is performed.
This is called deforming arthrosis of the hip joint, which most often affects people after 45 years. To restore damaged cartilage with coxarthrosis, drugs from the group of chondroprotectors (chondroitin sulfate, glucosamine hydrochloride, calf cartilage extract) are used. After several weeks of course use of drugs, their analgesic effect is observed. The severity of morning swelling of the hip joint decreases, the range of motion increases.
With coxarthrosis of severity 2 and 3, chondroprotectors are used to inhibit the destructive degenerative process. But with a rapidly progressing pathology, partial or complete immobilization of the leg can be avoided only by replacing the joint with an endoprosthesis.
What form of drugs is most effective
Chondroprotectors are made in the form of solutions for intraarticular, intramuscular administration, tablets, ointments and gels, powders for dilution in water. Each dosage form has its own advantages and disadvantages, which must be taken into account by the doctor when drawing up a therapeutic regimen. The type of pathology, the severity of its course, the degree of destruction of the hyaline cartilage, the number of developed complications are also important.
Manufacturers of ointments, creams, gels did not provide data on the ability of chondroprotectors to penetrate the skin, soft tissues into the articular cavities and accumulate there in sufficient therapeutic concentration. So far, the regenerative effect of the agents for local application has not been confirmed by the results of clinical studies. Therefore, doctors prescribe systemic drugs to patients.
Taking pills is the most convenient and safe way to treat articular pathologies. Chondroprotectors in this dosage form do not differ in pronounced toxicity, extremely rarely negatively affect the gastrointestinal tract. But the active ingredients of the tablets, after penetrating the systemic circulation, are carried by the blood throughout the body, getting into the damaged joint in a small amount.
Intramuscular injection of injectable solutions is usually practiced. The main components penetrate immediately into the bloodstream, bypassing the gastrointestinal tract. This allows you to increase the bioavailability of drugs. But the most effective way of administering drugs is intraarticular. Active ingredients immediately fall into the area of damaged cartilage, have the maximum therapeutic effect.
List of effective drugs
Each orthopedic practitioner, rheumatologist, traumatologist, vertebrologist has his own preferences in the appointment of chondroprotectors. The effectiveness of the drugs was confirmed by the results of x-ray studies, improving the well-being of patients. But there are exceptions to the rules when the demanded expensive chondroprotector did not help, and a cheap dietary supplement quickly weakened the symptoms of inflammatory or degenerative-dystrophic pathology.
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The chondroprotective effect of the drug is due to the properties of the active ingredient – a bioactive concentrate from small sea fish. Its composition in high concentration contains amino acid mucopolysaccharides, proteins, sodium, potassium, calcium, magnesium, iron, copper, zinc. For cartilage regeneration, 20 intraarticular or intramuscular injections of Alflutop are practiced.
The drug is available in the form of a lyophilisate, from which a solution is prepared for intramuscular administration. In total, 25 to 35 injections are prescribed during treatment. After 2 weeks of treatment, the anti-inflammatory and analgesic effect of Artradol is manifested. It persists for two months after discontinuation of the drug.
Combined agent with active ingredients glucosamine and chondroitin. Arthra often becomes the first choice in the treatment of deforming osteoarthritis. Available in the form of doubly convex tablets, packaged in plastic bottles No. 60, No. 90, No. 120. Often the determining criterion for choosing chondroprotectors is the compatibility of Arthra with glucocorticosteroids.
Under this name, in pharmacies are sold tablets made in domestic pharmaceutical factories. The German bioactive additive Glucosamine-Maximum is also very popular, which is available in the form of a powder for dilution in water and tablets for the preparation of an effervescent drink. To maintain a constant level of glucosamine in the joints, it is enough to take Glucosamine-Maximum once a day.
The drug makes up for endogenous glucosamine deficiency, has an anti-inflammatory, analgesic effect, and corrects the metabolism of cartilage. The therapeutic line of Don includes an injection solution, tablets, powders for the preparation of a drink. Preparations for oral administration are used within 1-3 months. Repeated course – after 2 months.
Toad stone is a bioactive supplement that eliminates pain, stopping inflammatory processes. Supplements with a chondroprotector are made in the form of capsules in red and gel in blue packaging. In addition to glucosamine, the composition of the external product includes phytoextracts that enhance and prolong the action of active ingredients.
Balm gel Horsepower – a cosmetic tool for body care. It contains natural ingredients, including fat-soluble vitamins, softening, moisturizing the skin, stimulating its regeneration. But to restore cartilage tissue with the help of even prolonged use of horsepower will not work. Due to the essential oils, dietary supplements show only weak analgesic activity.
The drug with components of plant origin is able to regulate metabolic processes in the cartilage, to provide anti-inflammatory and analgesic effects. The main ingredients of Piascledin are avocado and soybeans. The drug exhibits therapeutic activity after several weeks of course therapy, but it should be taken for at least six months.
Tissue repair stimulator is available as a solution for oral administration. The combined preparation of animal origin contains a glycosaminoglycan-peptide complex, which determines its pronounced therapeutic effect. Rumalon is administered deeply intramuscularly for 5-6 weeks. A second course of treatment – after consulting a doctor and examination.
Chondroprotector is available in one dosage form – in the form of capsules. Its active ingredient is chondroitin sulfate. During the use of Structum, pain decreases, the mobility of the affected joints improves. The therapeutic effect persists for several months (3-5) after the end of the course of treatment. If necessary, Structum is used after a short break, the duration of which the doctor sets individually.
The active ingredients of Teraflex are chondroitin sulfate and glucosamine hydrochloride. The recommended duration of treatment is from 3 to 6 months. Teraflex is often prescribed to patients with degenerative-dystrophic joint pathologies for several reasons. Firstly, it has a pronounced analgesic effect. Secondly, the drug goes well with NSAIDs and hormonal drugs.
The drug is made from cartilage in cattle and pigs by fermentation. Chondroitin sulfate is produced by domestic and foreign manufacturers to restore the cartilage surface of the joint, normalize the production of synovial fluid. A long course of taking the drug (from 3 months) increases the mobility of the joints, reduces pain, slows the progression of osteoarthritis, osteochondrosis, arthritis.
How to choose the right tool
Doctors treating joint diseases prefer pharmacological drugs over dietary supplements. If the patient is prescribed a bioactive supplement, then from trusted manufacturers. They include only chondroitin and (or) glucosamine, as well as auxiliary ingredients.
When choosing a chondroprotector in the form of tablets or capsules, one should not be guided by the number of active components. Some manufacturers add collagen or hyaluronic acid to the composition to attract customers. These organic compounds have chondroprotective activity, but most of them are excreted from the body without penetrating the articular cavities.
A characteristic feature of the use of drugs of this clinical and pharmacological group is a long therapeutic course. With pathologies of 1 severity, it is 3 months, and with progressive recurrent diseases – up to 2 years or more. Chondroprotectors are taken daily with plenty of water. If the medication was missed for any reason, then the next dose should not be doubled.
Single and daily doses of chondroprotectors, as well as the duration of the therapeutic course, are determined by the attending physician taking into account the form of the course and type of disease. Preference is given to drugs that are sufficient to take once a day. As a rule, they contain 750 mg of glucosamine and 500 mg of chondroitin.
For a faster and more complete restoration of damaged cartilage, doctors recommend combining chondroprotective medication with physiotherapeutic measures, massage procedures, regular exercise therapy and gymnastics.
The use of drugs with glucosamine and chondroitin does not cancel the use of drugs for pathogenetic therapy.
For pregnant and breastfeeding
Chondroprotectors in the form of injection solutions and tablets are not used during the period of gestation. No studies have been conducted by manufacturers, the results of which could confirm the absence of teratogenic effects in the preparations. Medicines can not be used during lactation, since there is no data on the penetration of their active ingredients into breast milk.
Most drugs with chondroprotective activity are not used in the treatment of children under 15 years of age. If necessary, the doctor may prescribe a systemic drug to the child. When calculating the dosages and duration of the course therapy, the determining factors are the weight, age of the child, and the severity of the course of the disease.
Chondroprotectors are generally well tolerated by patients. In some cases, dyspeptic disorders are noted – pain in the epigastric region, excessive flatulence, belching, heartburn, diarrhea or constipation. Sometimes patients complain of headaches, drowsiness, insomnia, dizziness, palpitations, swelling of the legs.
An absolute contraindication to the use of chondroprotectors is the individual intolerance of their active and auxiliary ingredients. Drugs are not prescribed for patients with renal failure, severe liver disease. They are not used during pregnancy, lactation, in childhood. With caution, treatment of patients with a predisposition to bleeding, with bronchial asthma, diabetes mellitus is carried out.