Osteoarthritis: Key elements in its pathogenesis and current agents for pathogenetic therapy

Abstract

Three main areas can be arbitrarily identified in the modern concept of treatment for osteoarthritis (OA); these are: 1) an impact on the progression of joint destruction; 2) suppression of peripheral pain mechanisms; and 3) inhibition of the central processes involved in the formation of pain sensation. Glucosamine and chondroitin sulfate (CS) have become the first agents that are able to retard the development of cartilage degeneration. They have been used in medical practice for more than 40 years. A number of clinical trials of these drugs have yielded favorable results during their use in patients with OA. Another agent containing amino sugars and CS – sea fish cartilage hydrolysate has more recently emerged. Clinical trials have demonstrated that it is able to significantly relieve OA-induced pain. To date, the main agent for the analgesic therapy of OA is considered to be nonsteroidal anti-inflammatory drugs (NSAIDs) that act on the peripheral mechanisms of pain and are widely used to treat diseases that are accompanied by chronic pain. However, a large-scale meta-analysis dealing with the experience with NSAIDs used to treat OA has shown that pain relief due to this therapy averaged only about 10 mm on a 100-mm visual analogue scale. To enhance the efficiency of therapy for OA, drug and non-drug treatments that affect the central mechanisms of pain in this disease are also used.

Keywords

• osteoarthritis
• peripheral pain mechanisms
• central pain mechanisms
• glucosamine
• chondroitin sulfate
• nonsteroidal anti-inflammatory drugs