Медицинский совет (May 2020)
Substantiation of strategic therapy of gonartrosis by chondroitin-containing drugs in diabetes mellitus patients
Abstract
Introduction. Currently, there is a high prevalence of type 2 diabetes mellitus (DM2) and osteoarthritis (OA). DM2 worsens the prognosis of the results of arthroplasty for OA, and also becomes an additional insecurity factor in the administration of traditionally often used non-steroidal anti-inflammatory drugs (NSAIDs) and in local injections of glucocorticosteroids. It is considered safer to prescribe chondroitin sulfate.Objective. Identification of clinical, radiological and arthrosonographic features of the manifestations of gonarthrosis with concomitant DM2 and related differences in the strategic conservative therapy.Methods. The study included 386 women with OA of knee joints (mean age 61,3 + 7,8 years). Patients were divided into groups of euglycemic status (group “OA”, n = 224) and comorbid according to DM2 (group “OA + DM2”, n = 162). The amplitude of an active mobility of the knee joints (KJ), the severity of gonarthrosis using the Lequesnealgo-functional index (AFI_Lequesne) and the WOMAC questionnaire were assessed. Radiography and arthrosonography of the KJ were performed.Results. In patients in group “OA + DM2” AFI_Lequesne were less by 18,2% (p = 0,0001), the total WOMAC index were less by 15,6% (p = 0,0001) compared with the “OA” group. In the group “OA + DM2”, the first x-ray stage was 2,6 times less common, and the third was 2 times more likely than the group “OA” (χ2 = 25,5; p = 0,001). The arthrosonography in the group “OA + DM2” detected a more pronounced thinning of the articular cartilage and more severe osteophytosis. The masking effect of DM2 on the symptoms of OA led to a rarer use of slowly acting symptom-modifying agents containing chondroitin in patients with “OA + DM2” in 1,7 times as compared with “OA” patients.Conclusions. In patients with gonarthrosis, concomitant DM2 minimizes symptoms, but accelerates the degeneration of the knee joints tissues. There is no information on the deterioration of the carbohydrate metabolism with a prolonged use of chondroitin sulfate, which suggests the safety of such therapy for patients with OA and concomitant diabetes mellitus type 2.
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