Клиническая эффективность и динамика системного воспаления при использовании диацереина у пациентов с остеоартрозом; влияние ожирения

Курята, А.В. and Черкасова, А.В. (2015) Клиническая эффективность и динамика системного воспаления при использовании диацереина у пациентов с остеоартрозом; влияние ожирения. Семейная медицина, № 5 (61). pp. 171-180. ISSN 2307 5112

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Abstract

Цель: оценить клиническую эффективность препарата диацерин (Флекцерин) у пациентов с остеоартрозом (ОА) коленных суставов и суставов других зон (суставы кистей рук и тазобедренные суставы) и его влияние на уровень системного воспаления, потребность в нестероидных противовоспалительных препаратах (НПВП), а также зависимость выраженности эффекта от наличия/отсутствия у пациента ожирения. Материалы и методы. Исследование включало 40 пациентов с ОА, разделенных на 2 группы в соответствии со схемой лечения, сопоставимых по основным демографическим и клиническим характеристикам. Пациенты основной группы (n=20, средний возраст 57,4±1,84 года) в составе комплексной терапии получали препарат Флекцерин в дозе 50 мг 1 раз в день в течение первых двух недель с последующим увеличением до 100 мг в сутки в 2 приема. Пациенты группы контроля (n=20, средний возраст 54,7±1,44 года) получали только симптоммодифицирующие препараты: аналгетики и НПВП. Срок наблюдения составил 2 мес. The purpose: to evaluate clinical efficiency of diacerein (flexcirin) in patients with knee osteoarthritis (OA) and OA of the hip and hand and it's influence on the level of systemic inflammation, the necessity in use of nonsteroidal anti inflammatory drugs (NSAIDs) and dependence of the clinical efficiency from obesity in patients with OA. Materials and methods. 40 patients fulfilling the American College of Rheumatology criteria for OA were enrolled in this 8 week study. All patients were divided into two groups, according to the receiving therapy. The main group consisted of 20 patients (mean age 57,4±1,84) whose standard therapy was complemented with flexirin in initial dosage 50 mg/day with farther increasing of daily dosage up to 100 mg/day after 2 weeks of treatment. The control group of patients (n=20, mean age 54,7±1,44) were treated only with symptomatic relief drugs: analgesics and NSAIDs. Results. Our study demonstrated a significant efficiency of flexirin on reducing pain and increasing functional mobility in patients with OA. According to the index WOMAC (Western Ontario and McMaster Universities OA Index) by the end of the study, level of pain decreased by 28,5% (р<0,05), and physical function improved by 32,4% (р<0,05) among patients of basic group. Wherein among patients with OA and obesity was demonstrated a lower effect against the increasing of functional activity comparing with patients with OA and normal body weight. During the study, a significant reduction of pain intensity was shown according to visual analog scale (VAS), a significant clinical effect was demonstrated after a month of flexerin treatment in patients with knee OA. The best level of pain reduction was shown among patients with knee OA and obesity – by 27,2% (р<0,05) without physical activity (at rest), and by 24,4% (р<0,05) during physical activity. Patients of control group didn't show any significant reduction of the following parameters. By the end of the study the reduction of systemic inflammation level was demonstrated in both groups, with best effect among patients of the basic group. There was also shown a significant increasing (р<0,05) of functional activity and quality of life according HAQ scale by 46,5% among patients of basic group, with the best effect among patients with knee OA and by 18,2% in control group. Our study also showed, that the necessity of daily use of NSAIDs decreased by 20% among patients of basic group on the background of compliance level increase. By the end of the study a reliable (р<0,05) decrease of anxiety and depressive disorders level was observed among patients of basic group, while in the control group there was only a tendency of anxiety level reduction, without any changes in the level of depressive disorders. Conclusions. During the study there was shown a clinical efficiency of flexcirin against the pain level reduction (in calm and during physical activity), the reduction of systemic inflammatory level, the increase in functional activity level on the background of lower level of necessity in daily NSAIDs use, higher compliance level and lower level of anxiety and depressive disorders. The obesity in patients with OA can be considered as a factor, slowing and reducing the effectiveness of pharmacological OA treatment. In this way, non pharmacological management of OA, such as weight loss, still remains one of the important strategies, as indicated in the international recommendations of OA treatment.

Item Type:	Article
Uncontrolled Keywords:	остеоартроз, лечение остеоартроза, модифицирующие препараты замедленного действия, диацереин, Флекцерин, остеоартроз, ожирение. osteoarthritis, osteoarthritis treatment, symptomatic slowacting drug for osteoarthritis (SYSADOA), diacerein, flexerin, osteoarthritis and obesity.
Subjects:	Internal diseases
Divisions:	Departments > Department of Internal Medicine 2 and phthisiology
Depositing User:	Анастасия Жигар
Date Deposited:	13 Sep 2016 13:47
Last Modified:	13 Sep 2016 13:47
URI:	http://repo.dma.dp.ua/id/eprint/880

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