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1.
Complement Ther Med ; 50: 102349, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32444040

RESUMO

INTRODUCTION: Osteoarthritis (OA) is characterised by synovial joint pain, functional disability and affects ∼13 % of people worldwide, of which ∼16-27 % report Knee-OA (KOA). Glucosamine (Glu) is the most widely used nutraceutical treatment for OA despite a lack of scientific consensus, therefore alternative nutraceutical treatments are required. The aim of this study was to investigate the effect of Lithothamnion species, seawater-derived magnesium and pine bark (Aq+) on pain, symptoms and improve physical function in symptomatic (sKOA), compared to Glu. METHODS: 358 participants were screened. In a double-blinded crossover pilot-trial, sKOA participant (n = 30) were randomly assigned to either the Glu group (2000 mg day-1) or Aq+ (3056 mg day-1) for 12 weeks (clinicaltrials.gov:NCT03106584). The Knee Injury and Osteoarthritis Outcome Score was used to assess subjective pain and symptoms. Timed-up-and-Go (TuG) and Six minute walking distance were used to assess functional change and analgesic use was recorded. RESULTS: Aq+ improved pain, with a large effect (P < 0.01, d' = 0.73, 95 %CI 0.201-1.265) and no change for Glu (d' = 0.38, P = 0.06). Only Aq+ improved pain (P < 0.05) for males (d' = 0.91, 95 %CI 0.162-1.667) and females (d' = 0.55, 95 %CI 0.210-1.299). In females, Aq+ improved TuG by -7.02 % (d' = 0.92, 95 %CI 1.699-0.141) while Glu worsened performance by 4.18 % (P = 0.04). Aq+ reduced analgesia by 71.6 %, compared to Glu (P = 0.02; d' = 0.82, 95 %CI 1.524-0.123). Aq+ was superior to Glu at improving pain, KOOS subscales, physical function and analgesia use in mild-sKOA. Given these data, Aq+ should be considered as a supplementary treatment for early-stage-KOA and may have the potential to reduce use of pain medication, although larger replication studies are required.


Assuntos
Clorófitas , Glucosamina/uso terapêutico , Minerais/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Pinus , Casca de Planta , Extratos Vegetais/uso terapêutico , Idoso , Analgésicos/uso terapêutico , Estudos Cross-Over , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Teste de Caminhada
2.
Ann Rheum Dis ; 79(6): 829-836, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32253185

RESUMO

OBJECTIVES: To evaluate the associations of regular glucosamine use with all-cause and cause-specific mortality in a large prospective cohort. METHODS: This population-based prospective cohort study included 495 077 women and men (mean (SD) age, 56.6 (8.1) years) from the UK Biobank study. Participants were recruited from 2006 to 2010 and were followed up through 2018. We evaluated all-cause mortality and mortality due to cardiovascular disease (CVD), cancer, respiratory and digestive disease. HRs and 95% CIs for all-cause and cause-specific mortality were calculated using Cox proportional hazards models with adjustment for potential confounding variables. RESULTS: At baseline, 19.1% of the participants reported regular use of glucosamine supplements. During a median follow-up of 8.9 years (IQR 8.3-9.7 years), 19 882 all-cause deaths were recorded, including 3802 CVD deaths, 8090 cancer deaths, 3380 respiratory disease deaths and 1061 digestive disease deaths. In multivariable adjusted analyses, the HRs associated with glucosamine use were 0.85 (95% CI 0.82 to 0.89) for all-cause mortality, 0.82 (95% CI 0.74 to 0.90) for CVD mortality, 0.94 (95% CI 0.88 to 0.99) for cancer mortality, 0.73 (95% CI 0.66 to 0.81) for respiratory mortality and 0.74 (95% CI 0.62 to 0.90) for digestive mortality. The inverse associations of glucosamine use with all-cause mortality seemed to be somewhat stronger among current than non-current smokers (p for interaction=0.00080). CONCLUSIONS: Regular glucosamine supplementation was associated with lower mortality due to all causes, cancer, CVD, respiratory and digestive diseases.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças do Sistema Digestório/mortalidade , Glucosamina/uso terapêutico , Neoplasias/mortalidade , Doenças Respiratórias/mortalidade , Suplementos Nutricionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Reino Unido/epidemiologia
3.
Diabetes Care ; 43(4): 719-725, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31988063

RESUMO

OBJECTIVE: Glucosamine is a widely used supplement typically taken for osteoarthritis and joint pain. Emerging evidence suggests potential links of glucosamine with glucose metabolism, inflammation, and cardiometabolic risk. We prospectively analyzed the association of habitual glucosamine use with risk of type 2 diabetes (T2D) and assessed whether genetic susceptibility and inflammation status might modify the association. RESEARCH DESIGN AND METHODS: This study analyzed 404,508 participants from the UK Biobank who were free of diabetes, cancer, or cardiovascular disease at baseline and completed the questionnaire on supplement use. Cox proportional hazards models were used to evaluate the association between habitual use of glucosamine and risk of incident T2D. RESULTS: During a median of 8.1 years of follow-up, 7,228 incident cases of T2D were documented. Glucosamine use was associated with a significantly lower risk of T2D (hazard ratio 0.83, 95% CI 0.78-0.89) after adjustment for age, sex, BMI, race, center, Townsend deprivation index, lifestyle factors, history of disease, and other supplement use. This inverse association was more pronounced in participants with a higher blood level of baseline C-reactive protein than in those with a lower level of this inflammation marker (P-interaction = 0.02). A genetic risk score for T2D did not modify this association (P-interaction = 0.99). CONCLUSIONS: Our findings indicate that glucosamine use is associated with a lower risk of incident T2D.


Assuntos
Bancos de Espécimes Biológicos/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Predisposição Genética para Doença/epidemiologia , Glucosamina/uso terapêutico , Inflamação/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/genética , Suplementos Nutricionais , Feminino , Seguimentos , Glucosamina/sangue , Humanos , Incidência , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
4.
Eur J Pharmacol ; 868: 172883, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31866406

RESUMO

Glucosamine (GlcN), a natural amino sugar in human body, was reported to exhibit anticancer activity against some tumors. In the present study, we evaluated the cytotoxicity and multi-drug resistance (MDR) reversal activity of GlcN on resistant MRP2-overexpressing ovarian cancer A2780RCIS cells. The cytotoxicity and MDR reversal activity of GlcN on cancer cells were measured by MTT assay. The effects of GlcN on MRP1 and MRP2 mRNA expression and function were evaluated by qRT-PCR and flow cytometry, respectively. The cell migration capacity of ovarian cancer cells were assessed in the presence or absence of GlcN using wound healing migration assay. Furthermore, the effects of GlcN on the mRNA expression of E-cadherin, vimentin and α-smooth muscle actin as Epithelial-Mesenchymal Transition (EMT)-related markers were evaluated by qRT-PCR. Our results indicated that glucosamine reduced the proliferation of human ovarian cancer cell lines (A2780) and its cisplatin resistant variant (A2780RCIS) in a dose-dependent manner. The IC50 values for A2780RCIS cells treated with cisplatin in the presence of different concentrations of GlcN (0, 1, 2 and 3 mM) for 72 h were 44.463 ± 1.603, 35.17 ± 0.025, 22.25 ± 0.018, 17.78 ± 0.012 µM respectively. Also GlcN decreased the expression of MRP1 and MRP2 mRNA in ovarian cancer cells. Our results further demonstrated that although GlcN had no significant effects on the expression of studied EMT-related markers in invasive A2780RCIS cells, it was able to inhibit their migration in vitro. According to these findings, GlcN could effectively enhance cisplatin cytotoxicity in resistant A2780RCIS cells.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Cisplatino/farmacologia , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Glucosamina/farmacologia , Neoplasias Ovarianas/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Cisplatino/uso terapêutico , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Feminino , Glucosamina/uso terapêutico , Humanos , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Neoplasias Ovarianas/patologia
5.
Artigo em Russo | MEDLINE | ID: mdl-31626227

RESUMO

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.


Assuntos
Sulfatos de Condroitina , Glucosamina , Osteoartrite , Manejo da Dor , Idoso , Sulfatos de Condroitina/uso terapêutico , Medicina Baseada em Evidências , Glucosamina/uso terapêutico , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Dor/etiologia
6.
Wiad Lek ; 72(9 cz 1): 1671-1675, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586981

RESUMO

Osteoarthritis is the disease connected with aging which is characterised by progressive degeneration of all elements building the joint but also influencing the muscles constituting motor unit with the affected joint. The effective and unified therapy has not been yet introduced despite the broad multi-site studies concentrating on metabolic pathways responsible for the development of the disease. The reason of which is probably its multifactorial aetiology. The treatment methods are based on decreasing of cartilage destruction activity, retardation of proinflammatory factors activity and fighting with pain. Physiotherapy, movement rehabilitation, painkillers, anti-inflammatory drugs, glucosamine sulphates and hyaluronic acids are used as therapeutic strategies. The methods recently introduced are platelet rich plasma concentrates and stem cells injected directly into the affected joint. The aim of this review article was the presentation of differential therapeutic options offered to patients in different stages of osteoarthritis.


Assuntos
Envelhecimento , Cartilagem/patologia , Osteoartrite/terapia , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Glucosamina/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico
7.
Clin Rheumatol ; 38(12): 3595-3607, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31376086

RESUMO

OBJECTIVES: This study aims to evaluate the efficacy of treatments for Kashin-Beck disease (KBD). METHOD: We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, SinoMed, Chinese National Knowledge Infrastructure, reference lists and published systematic reviews and registries of ongoing trials through May 2015 for randomised controlled trials (RCTs) of treatments for KBD. Outcomes of interest were pain, function, stiffness, overall clinical improvement, radiographic improvement (X-ray) and adverse events. Frequentist network meta-analyses were conducted using random-effects consistency model to assess the efficacy of treatments for KBD. RESULTS: Forty-four RCTs with 9815 participants were included in the review. In children or adolescents, selenium (risk ratio 1.88, 95% confidence interval (CI) 1.51-2.33), vitamin C (2.03, 1.40-2.95) and aspirin (2.14, 1.12-4.08) were effective for radiographic structure improvement. In adults, chondroitin plus glucosamine was the best for pain (standardised mean difference 1.46, 95% CI 1.07-1.85), followed by intra-articular injection of hyaluronic acid (IAH) (1.09, 0.70-1.48), chondroitin (0.84, 0.47-1.21), diclofenac (0.63, 1.18-1.08), naproxen (0.55, 0.12-0.98), meloxicam (0.52, 0.03-1.01) and glucosamine (0.40, 0.13-0.67) compared to placebo, with similar results for other clinical outcomes in adults. However, the strength of most evidence was limited by the small number of trials with low to moderate quality. CONCLUSIONS: Selenium supplement has demonstrated some benefits for structural improvement of the disease in children. Chondroitin, glucosamine, IAH and nonsteroid anti-inflammatory drugs are effective for symptom improvements of KBD in adults. Evidence of surgical and complementary treatments for symptoms and aspirin and vitamin C for structure has yet to be established.Key Points• There were 23 nutraceuticals, pharmaceuticals and surgical and complementary treatments assessed for Kashin-Beck disease (KBD) in randomised trials.• Among the 23 treatments, chondroitin, glucosamine, IAH and non-steroid anti-inflammatory drugs are more effective than placebo to relieve symptoms for adults with KBD.• Selenium supplement is more effective than placebo for radiographic improvement in children or adolescents.• The efficacy of surgeries, aspirin, vitamin C and complementary treatments for KBD has not been established yet.


Assuntos
Doença de Kashin-Bek/terapia , Condroitina/uso terapêutico , Suplementos Nutricionais , Glucosamina/uso terapêutico , Humanos , Manejo da Dor , Selênio/uso terapêutico
8.
J Nutr Sci Vitaminol (Tokyo) ; 65(3): 242-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257264

RESUMO

Care of the musculoskeletal system, including the muscles, joints, and bones, is important for a healthy life expectancy in today's aging society. The aim of this randomized, double-blind, placebo-controlled study was to investigate the effect of consumption of milk-fat globule membrane (MFGM) and glucosamine on joint function and physical performance. Participants were healthy Japanese men and women, aged 60-74 y, with a history of mild knee or low back pain at rest. They were randomized to receive tablets containing MFGM 1.0 g+glucosamine 1.5 g or placebo tablets for 8 wk. We assessed passive range of motion, active range of motion (self-reported VAS score), JKOM and JLEQ, and physical performance. Data were available for analysis for 25 participants in the active treatment group and 28 in the placebo group. The active group showed significant improvements in passive range of motion at the knee and active range of motion at both the knee and low back. The active group also showed significant improvements in some physical performance, including obstacle walking speed and speed of ascending stairs. The findings of this study suggest that consumption of a combination of MFGM and glucosamine may improve joint function and physical performance.


Assuntos
Glucosamina/uso terapêutico , Glicolipídeos/uso terapêutico , Glicoproteínas/uso terapêutico , Amplitude de Movimento Articular/efeitos dos fármacos , Caminhada/fisiologia , Idoso , Artralgia/tratamento farmacológico , Suplementos Nutricionais , Método Duplo-Cego , Teste de Esforço/efeitos dos fármacos , Feminino , Glucosamina/farmacologia , Glicolipídeos/farmacologia , Glicoproteínas/farmacologia , Humanos , Articulação do Joelho/fisiologia , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
9.
Eur J Phys Rehabil Med ; 55(5): 658-664, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31106560

RESUMO

BACKGROUND: Osteoarthritis (OA) is a theme currently representing an emerging topic for its increasing incidence. It is well known that it is a chronic disease that could lead to important long-lasting disability; this generates increasing costs for the health care system. OA treatment options vary: localization, etiology, grading and symptomatology should be considered before choosing the most adequate therapy. Currently, a modern approach to managing OA involves SYmptomatic Slow-Acting Drug for OsteoArthritis (SYSADOAs). However, while all preparations may claim to deliver a therapeutic level of glucosamine or chondroitin, not all of them are supported by clinical evidence. Recently the European Society for Clinical and Economic aspects of Osteoporosis, Osteoarthritis and musculoskeletal diseases (ESCEO), produced an evidenced based document providing practitioners with the latest clinical and economic information, thereby allowing them to optimize the management of knee OA. According to this report, only crystalline glucosamine sulphate and the pharmaceutical-grade chondroitin sulphate are considered as effective in the first line approach to treating knee OA as an alternative drug to acetaminophen. However, some OA guidelines do not agree are not concordant in recommending the use of SYSADOA, perhaps because they are generally considered as a class and distinctions among formulations are not made. AIM: Aim of this study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile in using SYSADOA. DESIGN: Delphi method Consenus Statement. POPULATION: Italian Physicians having expertise in Osteoarthritis management. METHODS: A committee of 11 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Sixty-three clinicians from a large number of Italian medical centers specialized in osteoarthritis management took part in a Delphi process which was aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical devices choice; treatment efficacy. CONCLUSIONS: Results from the Italian consensus on appropriateness of OA therapies in osteoarthritis seems to be in line with the stepwise approach proposed by the ESCEO algorithm, where crystalline glucosamine sulphate shows greater clinical efficacy than other glucosamine-based formulations, according to several independent meta-analyses. CLINICAL REHABILITATION IMPACT: This study may be used as a practical reference tool to help Italian physicians treat osteoarthritis patients using SYSADOA.


Assuntos
Sulfatos de Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Consenso , Técnica Delfos , Quimioterapia Combinada , Medicina Baseada em Evidências , Humanos , Itália , Inquéritos e Questionários
10.
J Fr Ophtalmol ; 42(7): 711-715, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31104873

RESUMO

PURPOSE: Glucosamine sulfate is one of the treatment options for patients with osteoarthritis of the knee. It has been postulated that glucosamine sulfate affects intraocular pressure (IOP). This study aimed to evaluate the effect of crystalline glucosamine sulfate on IOP in patients with osteoarthritis of the knee. METHODS: Forty-two patients with osteoarthritis of the knee were randomized into two groups. The first group of patients received 1500mg of crystalline glucosamine sulfate once daily for 6 months and the conventional treatment protocol. The second group of patients received only the conventional treatment protocol. IOP was recorded at the start of the study and at 6 weeks, 3 months, 6 months, and 9 months. RESULTS: The patient demographic data were not different between the two groups. There were no differences in the IOPs between the groups (P>0.05) nor differences in baseline IOPs within each group compared with each follow-up visit (P>0.05). CONCLUSIONS: Glucosamine sulfate is still an option without significant concern over elevated IOP in patients with osteoarthritis of the knee and normal ocular pressure.


Assuntos
Glucosamina/uso terapêutico , Pressão Intraocular/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Glucosamina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Tonometria Ocular , Resultado do Tratamento
11.
BMJ ; 365: l1628, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088786

RESUMO

OBJECTIVE: To prospectively assess the association of habitual glucosamine use with risk of cardiovascular disease (CVD) events. DESIGN: Prospective cohort study. SETTING: UK Biobank. PARTICIPANTS: 466 039 participants without CVD at baseline who completed a questionnaire on supplement use, which included glucosamine. These participants were enrolled from 2006 to 2010 and were followed up to 2016. MAIN OUTCOME MEASURES: Incident CVD events, including CVD death, coronary heart disease, and stroke. RESULTS: During a median follow-up of seven years, there were 10 204 incident CVD events, 3060 CVD deaths, 5745 coronary heart disease events, and 3263 stroke events. After adjustment for age, sex, body mass index, race, lifestyle factors, dietary intakes, drug use, and other supplement use, glucosamine use was associated with a significantly lower risk of total CVD events (hazard ratio 0.85, 95% confidence interval 0.80 to 0.90), CVD death (0.78, 0.70 to 0.87), coronary heart disease (0.82, 0.76 to 0.88), and stroke (0.91, 0.83 to 1.00). CONCLUSION: Habitual use of glucosamine supplement to relieve osteoarthritis pain might also be related to lower risks of CVD events.


Assuntos
Doenças Cardiovasculares/epidemiologia , Suplementos Nutricionais , Glucosamina/uso terapêutico , Dor/prevenção & controle , Doença das Coronárias/epidemiologia , Seguimentos , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Reino Unido/epidemiologia
12.
Clinics (Sao Paulo) ; 74: e722, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-31090795

RESUMO

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.


Assuntos
Competência Clínica/normas , Técnica Delfos , Medicina Baseada em Evidências/normas , Osteoartrite/terapia , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Brasil , Sulfatos de Condroitina/uso terapêutico , Consenso , Quimioterapia Combinada , Feminino , Glucosamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/normas , Osteoartrite/tratamento farmacológico , Osteoartrite do Joelho/terapia , Medicina Física e Reabilitação/normas , Guias de Prática Clínica como Assunto , Reumatologia/normas , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Aging Clin Exp Res ; 31(6): 807-813, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30982220

RESUMO

BACKGROUND: Osteoarthritis (OA) is a degenerative joint disease and a leading cause of adult disability. There is no cure for OA and there is no effective treatment to stop its progression. Current pharmacologic treatments such as analgesics and non-steroidal anti-inflammatory drugs may improve the pain and offer some relief but they do not affect the progression of the disease. The chronic intake of these drugs may result in severe adverse events. The aim of this review is to revise the effects of nutrition on cartilage metabolism and OA progression. METHODS: A systematic literature search was performed including those related to macro- and micro-nutrients' actions on cartilage and OA outcome. We selected peer-reviewed articles reporting the results of human clinical trials. RESULTS: Glucosamine and chondroitin sulfate have shown to delay OA knee progression in several clinical trials. The effectiveness of some products considered nutraceuticals has been widely reviewed in the literature. This article presents a general description of the effectiveness and mechanism of action of nutrients, vitamins, antioxidants and other natural components considered as part of the normal diet. Many in vitro studies indicate the efficacy of specific nutrients in cartilage metabolism and its involvement in OA. However, rigorous clinical studies needed to evaluate the efficacy of these compounds in humans are still missing. The influence of nutrients and diet on the metabolism of cartilage and OA could represent a long-term coadjuvant alternative in the management of patients with OA. Effects of diet modifications on lipid and cholesterol profiles, adequate vitamin levels and weight reduction in obese patients could influence the course of the disease. CONCLUSION: This review demonstrates that nutrition can improve the symptoms of OA. Glucosamine and chondroitin sulfate have shown robustly to delay the progression of knee OA in several well-designed studies, however more controlled clinical trials are needed to conclude that nutritional changes slow down the progression of the disease.


Assuntos
Cartilagem/metabolismo , Progressão da Doença , Estado Nutricional , Osteoartrite , Cartilagem/efeitos dos fármacos , Sulfatos de Condroitina/uso terapêutico , Glucosamina/uso terapêutico , Humanos , Osteoartrite/dietoterapia , Osteoartrite/tratamento farmacológico , Vitaminas/uso terapêutico
14.
Biomater Sci ; 7(7): 2716-2728, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31033977

RESUMO

Osteoarthritis (OA) is a chronic joint disease resulting from joint inflammation and damage. In this study, we employed a boundary lubricant known as a 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) liposome for loading of an anti-inflammatory drug d-glucosamine sulphate (GAS) to construct a treatment strategy allowing for sustained anti-inflammation and reduced damage. This kind of drug-loaded nanocarrier integrates the anti-inflammatory effect of the GAS and the lubrication ability of DSPC liposomes without the involvement of complex synthesis processes leading to easier popularization. Our experimental results indicated that the GAS-loaded DSPC liposomes could release GAS in a sustained manner while providing good lubrication in pure water (H2O) and phosphate buffered saline (PBS). Moreover, the GAS-loaded DSPC liposomes prepared at a 2 : 8 molar ratio in PBS exhibited a greater entrapment efficiency, lower GAS release rate and smaller friction coefficient as compared to those prepared in H2O. The superiority of the drug release and lubrication ability achieved with the GAS-loaded DSPC liposomes in PBS were elucidated on the basis of salt-induced enhancement in liposomal stability and hydration lubrication by the hydrated salt ions. Such GAS release accelerated the viability and proliferation of primary mouse chondrocytes while also providing the anti-inflammatory and chondroprotective potential for tumor necrosis factor (TNF-α) induced chondrocyte degeneration through the down-regulation of pro-inflammatory cytokines, pain related gene and catabolic proteases, as well as the up-regulation of anabolic components. We envision that the GAS-loaded DSPC liposomes could represent a promising new strategy for clinical treatment of OA in the future.


Assuntos
Glucosamina/administração & dosagem , Glucosamina/uso terapêutico , Lipossomos/química , Lubrificantes/administração & dosagem , Lubrificantes/uso terapêutico , Osteoartrite/tratamento farmacológico , Fosforilcolina/química , Animais , Condrócitos/efeitos dos fármacos , Condrócitos/metabolismo , Preparações de Ação Retardada , Regulação da Expressão Gênica/efeitos dos fármacos , Glucosamina/farmacologia , Lubrificantes/farmacologia , Camundongos , Fator de Necrose Tumoral alfa/metabolismo , Água/química
15.
PLoS One ; 14(2): e0211999, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794553

RESUMO

OBJECTIVE: This pilot study assessed the efficacy of a knee guard device, which used magnetophoresis to transdermally deliver Glucosamine, Chondroitin and Hyaluronic Acid in a cohort of individuals with prior knee injury. The aim was to determine if the change in physical function and pain with the knee guard device was equivalent to the change produced by an established topical NSAID formulation containing diclofenac sodium 1%. METHODS: A randomized, controlled, equivalence trial evaluated outcomes following treatment with the knee guard device or NSAID formulation. The study recruited 114 male participants (aged 40-55 years). Participants were randomly allocated to wear the knee guard device or to use a NSAID gel daily for two weeks. The primary outcomes were the knee injury osteoarthritis function score (KOOS-F) and an aggregated function score (AFS). The lower extremity functional scale (LEFS), pain numerical rating scale (PNRS), global rating of change (GROC) and other KOOS scores were also evaluated. RESULTS: Multiple linear regression analyses indicated that there were no significant differences between the interventions for changes in the primary outcomes of AFS and KOOS_F. The 95% confidence interval (-2.89 to 5.15) of the estimated treatment difference for KOOS-F was within the lower (-5.61) and upper (5.61) bounds of the 7% equivalence margin for that measure, The mean value for the AFS was within, but the 95% CI (-3.11 to 7.37) exceeded the 7% equivalence margin (-2.97 to 2.97) for that measure. There was a significant difference in PNRS, which favored the knee guard device. CONCLUSION: The knee guard device demonstrated equivalence for the KOOS-F measure but not the AFS measure of function over the two week trial period when compared to a widely available NSAID gel that has been shown to be superior to placebo. The knee guard produced a greater reduction in pain report (p = 0.002) than the NSAID gel. Users of the knee guard device experienced more skin irritation than participants using the NSAID gel. Further research is required to fully evaluate the therapeutic potential of this innovative treatment approach.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Desenho de Equipamento/instrumentação , Traumatismos do Joelho/terapia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Condroitina/administração & dosagem , Condroitina/uso terapêutico , Composição de Medicamentos , Glucosamina/administração & dosagem , Glucosamina/uso terapêutico , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/uso terapêutico , Fenômenos Magnéticos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Resultado do Tratamento
16.
J Biol Chem ; 294(2): 608-622, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30455348

RESUMO

The aim of the current study was to investigate the effects of glucosamine (GlcN) on septic lethality and sepsis-induced inflammation using animal models of mice and zebrafish. GlcN pretreatment improved survival in the cecal ligation and puncture (CLP)-induced sepsis mouse model and attenuated lipopolysaccharide (LPS)-induced septic lung injury and systemic inflammation. GlcN suppressed LPS-induced M1-specific but not M2-specific gene expression. Furthermore, increased expressions of inflammatory genes in visceral tissue of LPS-injected zebrafish were suppressed by GlcN. GlcN suppressed LPS-induced activation of mitogen-activated protein kinase (MAPK) and NF-κB in lung tissue. LPS triggered a reduction in O-GlcNAc levels in nucleocytoplasmic proteins of lung, liver, and spleen after 1 day, which returned to normal levels at day 3. GlcN inhibited LPS-induced O-GlcNAc down-regulation in mouse lung and visceral tissue of zebrafish. Furthermore, the O-GlcNAcase (OGA) level was increased by LPS, which were suppressed by GlcN in mouse and zebrafish. OGA inhibitors suppressed LPS-induced expression of inflammatory genes in RAW264.7 cells and the visceral tissue of zebrafish. Stable knockdown of Oga via short hairpin RNA led to increased inducible nitric oxide synthase (iNOS) expression in response to LPS with or without GlcN in RAW264.7 cells. Overall, our results demonstrate a protective effect of GlcN on sepsis potentially through modulation of O-GlcNAcylation of nucleocytoplasmic proteins.


Assuntos
Glucosamina/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/etiologia , Lesão Pulmonar/tratamento farmacológico , Lesão Pulmonar/etiologia , Sepse/complicações , Sepse/tratamento farmacológico , Animais , Anti-Inflamatórios/uso terapêutico , Modelos Animais de Doenças , Inflamação/patologia , Lesão Pulmonar/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Infiltração de Neutrófilos/efeitos dos fármacos , Células RAW 264.7 , Sepse/patologia , Peixe-Zebra
17.
Int J Rheum Dis ; 22(3): 376-385, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28332780

RESUMO

Symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) are recommended for the medium- to long-term management of knee osteoarthritis (OA) due to their abilities to control pain, improve function and delay joint structural changes. Among SYSADOAs, evidence is greatest for the patented crystalline glucosamine sulfate (pCGS) formulation (Mylan). Glucosamine is widely available as glucosamine sulfate (GS) and glucosamine hydrochloride (GH) preparations that vary substantially in molecular form, pharmaceutical formulation and dose regimen. Only pCGS is given as a highly bioavailable once-daily dose (1500 mg), which consistently delivers the plasma levels of around 10 µmol/L required to inhibit interleukin-1-induced expression of genes involved in the pathophysiology of joint inflammation and tissue destruction. Careful consideration of the evidence base reveals that only pCGS reliably provides a moderate effect size on pain that is higher than paracetamol and equivalent to non-steroidal anti-inflammatory drugs (NSAIDs), while non-crystalline GS and GH fail to reach statistical significance for pain reduction. Chronic administration of pCGS has disease-modifying effects, with a reduction in need for total joint replacement lasting for 5 years after treatment cessation. Pharmacoeconomic studies of pCGS demonstrate long-term reduction in additional pain analgesia and NSAIDs, with a 50% reduction in costs of other OA medication and healthcare consultations. Consequently, pCGS is the logical choice, with demonstrated medium-term control of pain and lasting impact on disease progression. Physician and patient education on the differentiation of pCGS from other glucosamine formulations will help to improve treatment selection, increase treatment adherence, and optimize clinical benefit in OA.


Assuntos
Antirreumáticos/uso terapêutico , Glucosamina/uso terapêutico , Osteoartrite/tratamento farmacológico , Patentes como Assunto , Animais , Antirreumáticos/efeitos adversos , Antirreumáticos/economia , Antirreumáticos/farmacocinética , Análise Custo-Benefício , Cristalização , Composição de Medicamentos , Custos de Medicamentos , Glucosamina/efeitos adversos , Glucosamina/economia , Glucosamina/farmacocinética , Humanos , Osteoartrite/diagnóstico , Osteoartrite/economia , Educação de Pacientes como Assunto , Resultado do Tratamento
18.
J Knee Surg ; 32(1): 46-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30477045

RESUMO

The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.


Assuntos
Osteoartrite do Joelho/terapia , Terapia por Acupuntura , Analgésicos não Entorpecentes/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Braquetes , Sulfatos de Condroitina/uso terapêutico , Curcuma , Terapia por Exercício , Órtoses do Pé , Glucosamina/uso terapêutico , Humanos , Sobrepeso/terapia , Treinamento de Resistência , Terapia por Ultrassom , Perda de Peso
19.
Ter Arkh ; 91(12): 135-141, 2019 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-32598601

RESUMO

Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.


Assuntos
Envelhecimento , Anti-Inflamatórios não Esteroides/uso terapêutico , Fragilidade/complicações , Osteoartrite/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/uso terapêutico , Dor Crônica , Idoso Fragilizado , Glucosamina/uso terapêutico , Humanos , Osteoartrite/complicações , Síndrome
20.
JAMA ; 320(24): 2564-2579, 2018 12 25.
Artigo em Inglês | MEDLINE | ID: mdl-30575881

RESUMO

Importance: Even though osteoarthritis is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term disease management. Objective: To search, review, and analyze long-term (≥12 months) outcomes (symptoms, joint structure) from randomized clinical trials (RCTs) of medications for knee osteoarthritis. Data Sources and Study Selection: The databases of MEDLINE, Scopus, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched until June 30, 2018 (MEDLINE alerts through August 31, 2018) for RCTs of patients with knee osteoarthritis that had treatment and follow-up lasting 1 year or longer. Data Extraction and Synthesis: Data at baseline and at the longest available treatment and follow-up of 12 months' duration or longer (or the change from baseline) were extracted. A Bayesian random-effects network meta-analysis was performed. Main Outcomes and Measures: The primary outcome was the mean change from baseline in knee pain. Secondary outcomes were physical function and joint structure (the latter was measured radiologically as joint space narrowing). Standardized mean differences (SMDs) and mean differences with 95% credibility intervals (95% CrIs) were calculated. Findings were interpreted as associations when the 95% CrIs excluded the null value. Results: Forty-seven RCTs (22 037 patients; mean age range, mostly 55-70 years; and a higher mean proportion of women than men, around 70%) included the following medication categories: analgesics; antioxidants; bone-acting agents such as bisphosphonates and strontium ranelate; nonsteroidal anti-inflammatory drugs; intra-articular injection medications such as hyaluronic acid and corticosteroids; symptomatic slow-acting drugs in osteoarthritis such as glucosamine and chondroitin sulfate; and putative disease-modifying agents such as cindunistat and sprifermin. Thirty-one interventions were studied for pain, 13 for physical function, and 16 for joint structure. Trial duration ranged from 1 to 4 years. Associations with decreases in pain were found for the nonsteroidal anti-inflammatory drug celecoxib (SMD, -0.18 [95% CrI, -0.35 to -0.01]) and the symptomatic slow-acting drug in osteoarthritis glucosamine sulfate (SMD, -0.29 [95% CrI, -0.49 to -0.09]), but there was large uncertainty for all estimates vs placebo. The association with pain improvement remained significant only for glucosamine sulfate when data were analyzed using the mean difference on a scale from 0 to 100 and when trials at high risk of bias were excluded. Associations with improvement in joint space narrowing were found for glucosamine sulfate (SMD, -0.42 [95% CrI, -0.65 to -0.19]), chondroitin sulfate (SMD, -0.20 [95% CrI, -0.31 to -0.07]), and strontium ranelate (SMD, -0.20 [95% CrI, -0.36 to -0.05]). Conclusions and Relevance: In this systematic review and network meta-analysis of studies of patients with knee osteoarthritis and at least 12 months of follow-up, there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo. Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis.


Assuntos
Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Celecoxib/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Manejo da Dor/métodos , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Seguimentos , Glucosamina/uso terapêutico , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade
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