OSTEOARTHRITIS OF KNEE JOINTS: THE EFFECT OF CONCOMITANT THERAPY IN COMORBID PATHOLOGY

Abstract

Introduction. Osteoarthritis is the most common disease of the musculoskeletal system, characterized by chronic inflammation and involvement of all components of the joint in the pathological process. Osteoarthritis leads to a decrease in the quality of life, disability of the population, and an increase in mortality. According to experts, osteoarthritis affects about 240 million people worldwide, including approximately 10% of men and 18% of women over the age of 60. In another epidemiological study by American scientists, it was found that that symptomatic knee osteoarthritis occurs in approximately 7% of adults over the age of 25. The prevalence of osteoarthritis is higher in women than in men and increases with age (the trend is present until the age of 70). Approximately 9% of men and 30% of women have at least one joint affected, 11 % and 23% have at least two. Osteoarthritis ranks the 1st position in the structure of musculoskeletal pathology, the 2nd in the number of visits to a family doctor, giving the pass only to cardiovascular diseases, and the 3rd commonest cause of disability. The aim of this study is to analyze and emphasize modern findings regarding the pathogenetic links between osteoarthritis and concurrent comorbid conditions to provide a rationale for novel approaches to enhance the treatment of patients with this pathology. Furthermore, the study aims to evaluate the impact of treatment in patients with gonarthrosis who also present comorbid conditions, with a specific focus on the use of chondroprotective agents such as chondroitin sulphate and glucosamine sulphate, as well as prescription crystalline glucosamine sulphate. Additionally, the study assesses the effects of medications like sartans (e.g., vazar/losartan), statins (e.g., rosart), and nonsteroidal anti-inflammatory drugs (e.g., celecoxib, ibuprofen, diclofenac potassium) in this context. Materials and methods. For this study, we conducted a comprehensive scientific search across both printed and electronic publications and scientific databases. Our research focused on analyzing, comparing, and synthesizing information related to the interplay between osteoarthritis and comorbid pathologies. The study was conducted at the Rheumatology Center at M.V. Sklifosovskiy Poltava Regional Clinical Hospital, which is affiliated with the Department of Family Medicine and Therapy at the Poltava State Medical University. We enrolled a total of 100 participants, comprising both outpatients and inpatients. Among the participants, 81% were women, while 19% were men. Their ages ranged from 48 to 73 years, and all of them presented with primary gonarthrosis at the I-II X-ray stage according to the Kellgren and Lawrence classification in combination with comorbid pathologies. Results. During a 3-month follow-up period, patients under the age of 50 years had mild and moderate manifestations of metabolic syndrome and polymorbid conditions including chronic obstructive pulmonary diseases, lesions of the genitourinary system. Most often, one, rarely two comorbid diseases and one or two diseases that had no proven connection with osteoarthritis were detected. At the age of 50-60, such comorbid processes as arterial hypertension, coronary heart disease, heart failure, obesity, type 2 diabetes, diseases of the digestive system, and polymorbid processes as chronic obstructive pulmonary disease, lesions of the genitourinary system, skin, diseases of the upper respiratory tract, depressive states demonstrated an increasing prevalence. Conclusions. This study has demonstrated a significant clinical effect from applying 3-month therapy that we developed. The therapy, including crystalline glucosamine sulphate and celecoxib, yielded 92% positive response in patients of the main group with osteoarthritis and comorbid pathology. It resulted in a significant reduction in pain, improved joint mobility, enhanced ability to perform daily activities, and positive shifts in laboratory indicators. This led to an improvement in the quality of life, manifested by normalized blood pressure, reduced cardiac and joint pain, and diminished reliance on nonsteroidal anti-inflammatory and antihypertensive medications.