Difficult-to-treat osteoarthritis – justification for multimodal treatment tactics

Abstract

Effective pain control is the most important clinical task in the treatment of osteoarthritis (OA). The International Expert Council, which discussed the possibility of introducing the principle of "treatment to target" to OA treatment, recognized the PASS (patient acceptable symptoms state) index as the most reasonable criterion for the successful treatment of this disease. However, according to several population studies, it is not possible to achieve a significant improvement in OA in 20–30% of patients. Factors that may be responsible for an inadequate response to the treatment of OA are severe structural changes in the joints, dysfunction of the nociceptive system (neuroplastic changes, central sensitization), psychoemotional disorders and comorbid pathologies. Therefore, the choice of therapeutic tactics in patients with OA who have moderate or severe pain should be individualized and take into account the phenotype of the disease, the characteristics of the clinical situation and the presence of comorbid pathologies. Leading experts in OA believe that the most rational approach to the management of this disease is a multidisciplinary, multimodal treatment that includes the complex use of nonsteroidal anti-inflammatory drugs, local injection therapy, Symptomatic Slow Acting Drugs for Osteoarthritis (SYSADOA) and non-pharmacological approaches. There is currently a strong evidence base confirming the efficacy and safety of SYSADOA (particularly the combination of glucosamine and chondroitin). This allows us to consider SYSADOA as a mandatory component of OA treatment, regardless of stage, phenotype and concomitant pathology. A new direction of OA therapy is the use of native (undenatured) collagen preparations, the effect of which is associated with the formation of immunological tolerance to autoantigens of this protein and a reduction in the severity of chronic joint inflammation. Several clinical studies have confirmed the effectiveness of native collagen supplements. The appearance of a new dietary supplement containing native collagen, glucosamine, chondroitin, B vitamins and ginger extract expands the possibilities of pharmaconutraceutical support for patients with OA.