Abstract
Osteoarthritis is a degenerative non-inflammatory disease of the joints, mostly nasal, affecting the cartilage, articular capsule, bone and surrounding tissues. This disease causes pain, discomfort during movement and subsequent limitation, until the joint momentum disappears completely.
Therapy is complex and includes regimen measures (weight reduction, rehabilitation, lifestyle change, work commitment), physical therapy (rehabilitation, balneotherapy), medicamentous treatments (analgesics, antiphlogistics, antirheumatics, chondroprotectives) to surgical treatment (joint lining removal, correction) osteotomy to joint replacement). One of the treatment options for medicaments, as mentioned above, is the so-called cheroprotective.
These are medicines named by the Australian rheumatologist Ghosh in 1991 to help, as the name suggests, protect the cartilage (chondros), or better, to support the structure and function of the cartilage. Since this effect has not been clearly demonstrated in any "chondroprotective" yet, it is not advisable to name these drugs.
Although a protective effect has not been demonstrated, a symptomatic effect of the drugs was found, which manifested itself first after some slow onset and persisted in the long term. Therefore, these drugs are conveniently called SYSADOA (Symptomatic, Slow Acting Drugs Against Osteoarthritis).
Among the active ingredients of these drugs are substances that are mostly found in cartilage, such as chondroitin sulfate, glycosamine, hyaluronic acid, various forms of collagen, etc. However, some substances that have nothing to do with cartilage have the same effect.
The relatively easy availability and safety of most of these substances allowed them to be offered as food supplements, freely available and used without prescription. Unfortunately, the efficacy of these substances is not the same despite the same chemical formula.
It depends on the purity of the substance, the method of production and the origin of the basic raw materials. The assessment of the efficacy of individual drugs, as well as dietary supplements, is only possible on the basis of credible studies comparing the effect of the drugs by an independent observer who does not know what drug the patient was taking.
These studies are called 'blind studies' and the effect of drugs is compared to either placebo (an inactive safe substance in the same form as the active substance) or to another active substance where the relative degree of effectiveness is compared. Only on the basis of such statistically significant (ie a sufficient number of patients monitored) studies can the quality of the drug be assessed.
Practically the only study to monitor the efficacy of a dietary supplement that could be classified as a so-called chondroprotective was similar to a study conducted in several orthopedic and rheumatology departments in the Czech Republic, comparing the efficacy of collagen lysate and glucosamine. Principle of the study Patients suffering from some degree of osteoarthritis of the knee were given a drug that was either collagenous lysate or glucosamine at a dose that is commonly used for 3 months.
Patients were monitored regularly to assess their condition. Only at the end of the study and evaluation of all investigated factors was it differentiated which of the monitored patients used the first and the second substance.
These data were compared with each other. It was therefore a typical multicentre, blind study of drug efficacy and side effects.
Results This study showed clear improvement and significant differences in both joint pain and symptoms of OAK patients treated with EHC (colates). The mean reduction from baseline to week 2, 4, 8 and 12 in ECE 10 g once daily and 1.5 g GS, respectively, was: reduction in OAK pain intensity at target knee: 0.18, 0.97, 1.63 and 2 14 for colates (r) and 0.04, 0.23, 0.57 and 0.86 for glucosamine (p0.05).
The WOMAC index decreased to 15 points at the last visit (day 90) in 16 patients with colates (r) (34.04%) (p0.05) and in 6 patients with glucosamine (13.04%). Total pain index for painful joints: colates (r) 1.6 (p0.05) and glucosamine 1.8.
Total score index for swollen joints: colates (r) 0.5 (p0.05) and glucosamine 0.7. Overall assessment of patients' effect as a sum of "good and ideal" improvements: 80.8% for colates (r) and 46.6% for glucosamine (p0.05).
ECE (colatech (r)) showed a significantly greater improvement than GS in the SF-36 Quality of Life Questionnaire in the physical health index (42.0 for colates and 40.0 for glucosamine, ie ECE is almost twice as effective, GS reaches only 57, 6% ECE efficiency). The incidence of side effects was similar in both groups.
Both ECE (colatech (r)) and GS preparations were well tolerated. Conclusions In this experiment, ECE (colatech (r)) was more effective than GS in relieving pain and disability.
ECE 10 g provided effective pain relief in OAK patients with better efficacy than GS 1.5 g once daily and both products were well tolerated.