Добре дошли в сайта на д-р Севдалина Ламбова, дм, ревматолог





Osteoarthritis (OA) is the most common chronic joint disorder everywhere in the world, whose prevalence increases in the aging process. OA is defined by focal lesions of the articular cartilage, which is the primarily affected organ in OA, combined with a hypertrophic reaction (sclerosis) in the subchondral bone, new bone formation (osteophytes) of the joint margins and secondary synovial inflammation. According to presence or absence of clear causative factor the OA is primary and secondary. The main forms of secondary OA are posttraumatic, OA in congenital or developmental diseases, OA associated with metabolic disease, crystal arthropathies, OA in the evolution of inflammatory joint diseases and endocrine disorders. The primary OA typically affects the weight-bearing joints (knees and hips) as well as hands (distal and proximal interphalangeal joints first carpo-metacarpal joint), feet (first metatarsophalangeal joint) and spine.    


            The economic and social impact of the disease is great, which is associated with the high frequency of OA in the general population, the impaired function and disability, which it causes and the significant costs for treatment. The treatment of OA aims pain control, reduction of the disability and improvement of function and quality of life. It includes multidisciplinary approach with non-pharmacological measures, patient education, physiotherapy, weight reduction, pharmacological therapy, orthoses, mobility aids, surgical treatment. The pharmacological treatment includes classical approach with control of pain and inflammation (analgetics, nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgetics, intra-articular corticosteroids) and administration of SYmptomatic Slow Acting Drugs for OsteoArthritis (SYSADOAs), which are supposed to possess potential for slowing the disease progression. Currently, there is no medication from this group approved as disease-modifying agent in OA. The group of SYSADOAs includes glucosamine sulfate, chondroitin sulfate, diacerein, unsaponifiables extract of soybean and avocado given orally       and intra-articular hyaluronic acid.


            OA is a disease, whose frequency enhances significantly during aging. In the age group between 65 and 75 years the number of people with radiological and clinically manifested OA increases significantly. In this population there is also a high frequency of cardiovascular diseases (such as arterial hypertension, ischemic heart disease) and most of the patients from this age group receive combined medical treatment. The administration of NSAIDs as symptomatic therapy in OA patients is associated with increased cardiovascular risk. It is a result from the mechanism of action of these medications as they inhibit prostacyclin synthesis in the vascular endothelium. In addition, their administration in elderly people above 70 years, who often have concomitant pathology (metabolic syndrome, arterial hypertension, ischemic heart disease, myocardial infarction, cerebrovascular disease, chronic lower limb arterial insufficiency) further increases the risk. Other classical adverse effects of NSAIDs are complications from gastrointestinal tract, which develop as a result from the inhibition of the enzyme cyclooxygenase -1 in gastrointestinal mucosa. In patients above 65 years physiologically increased vulnerability of gastrointestinal system develops. Long-term administration of NSAIDs in high doses, history for peptic ulcer, low-dose aspirin intake, concomitant administration of anticoagulants and corticosteroids are well-known factors associated with increased risk of gastrointestinal complications.


            Considering the risk for gastrointestinal and cardiovascular complications in elderly patients with OA, who use NSAIDs for a long period, intriguing is the aim to improve the symptoms and functional capacity and eventually to slow the disease progression via medications with good safety profile, which reduce the consumption of NSAIDs


                                                                                  Dr Sevdalina Lambova, MD, PhD