Injectable SYSADOA in the treatment of post-traumatic osteoarthritis
Authors: Burianov O.A. , Omelchenko T.M. 
Published: November 2024

Background. Despite the ambiguity and controversy of modern views on the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) as the basic therapy, numerous studies have shown that the early administration of these drugs is safe and effective, and in combination with anti-inflammatory treatment gives a better result and prevents degenerative and inflammatory damage to articular cartilage. There are requirements for ­SYSADOA to include them in guidelines and protocols for the treatment of osteoarthritis. These products must be registered medicinal products (prescription pharmaceutical preparations) with appropriate certification regarding the composition, quality and safety for long-term use, use in patients with multimorbidity, as well as when taking with other medicines. The dosage form should ensure the best compliance. The purpose was to evaluate the clinical effectiveness and safety of the injectable form of SYSADOA, namely glucosamine sulfate, in the treatment of patients with post-traumatic osteoarthritis of the ankle joint of the early stages (1–2 according to Kellgren and Lawrence) after surgical treatment for ankle fractures sustained from 6 months to 2 years ago. Material and methods. The design of the clinical research is comparative, prospective, controlled in parallel groups with the level of evidence IIB. Patients of the main group (N1 = 20) were operated for injury and had a radiologically and clinically confirmed diagnosis of post-traumatic osteoarthritis of the ankle joint stage I–II (according to Kellgren and Lawrence). In order to eliminate the phenomena of osteoarthritis exacerbation, patients were prescribed a course of nonsteroidal anti-inflammatory drugs (NSAIDs) with intramuscular injection of meloxicam 1.5 ml once a day for 10 days. Subsequently, intramuscular glucosamine sulfate (ampoules of 200 mg/ml, 2.0 ml) 400 mg 3 times a week was prescribed for 6 weeks. In the comparison group (N2 = 20), the patients received only a course of NSAIDs for 10 days similar to the main group, and subsequently, only observation and assessment of the functional state of the affected joint were carried out. The treatment outcomes were evaluated clinically 10 days and 2 months after the start of the treatment by the dynamics of pain syndrome reduction according to the visual analogue scale and the functional state of the ankle joint (AOFAS), as well as based on the frequency of adverse events and side effects in the observation groups. Results. After 2 weeks, the intensity of the pain syndrome according to the visual analogue scale in the N1 group was 18.7 ± 3.2, and in the N2 group, it was 19.1 ± 2.9 (p > 0.1). After 2 months, the ratio between groups N1/N2 was 12.2 ± 2.3 versus 17.9 ± 1.9 (p < 0.05). The functional state of the ankle joint assessed according to the AOFAS after 2 weeks in the N1 group was 78.7 ± 2.3 points versus 79.1 ± 2.6 points in the N2 group (p > 0.1). After 2 months, the AOFAS score in the groups N1 and N2 was 91.7 ± 2.6 points versus 79.4 ± 3.2 points (p < 0.05). No negative consequences associated with intramuscular administration of meloxicam and glucosamine sulfate were recorded. Conclusions. In patients with early stages of post-traumatic osteoarthritis of the ankle joint, a 6-week treatment with the use of an injectable form of glucosamine sulfate provides effective pain relief and improves function. A combination of NSAIDs and the injectable form of SYSADOA showed no adverse reactions in the clinical observation group, provided that the recommended dose and regimen were followed, as well as consideration and prevention of gastrointestinal and cardiovascular risks.