Naturocetic Compunds as Structure-Modifying Drugs
Naturocetic Compunds as Structure-Modifying Drugs
Purpose of review: Several entities have been investigated carefully for the symptomatic and structural management of osteoarthritis. This review reports recent findings suggesting that such compounds may delay the structural progression of osteoarthritis.
Recent findings: The most compelling evidence of a potential for inhibiting the structural progression of osteoarthritis has been obtained with glucosamine sulfate, whereas preliminary results obtained in patients with osteoarthritis of the hands also suggest that chondroitin sulfate could be used in the same indication. At any rate, these two compounds have clearly demonstrated a symptomatic action, mainly in osteoarthritis of the lower limbs. Patients with the less severe radiographic osteoarthritis will experience, in the long run, the most dramatic disease progression in terms of joint space narrowing. Such patients may be particularly responsive to structure-modifying drugs.
Summary: Glucosamine sulfate has demonstrated its ability to reduce the progression of osteoarthritis in the lower limbs. The preliminary results obtained in the hands suggest that chondroitin sulfate could also be of interest in this indication. An important issue is that all the conclusive studies with such chemical entities resulted from the use of prescription medicines, not over-the-counter pills or food supplements.
When considering the importance of medical issues, the first factor to take into account is the prevalence of the disorder. Arthritis, specifically osteoarthritis (OA), has been shown to have a high prevalence wherever such statistics are available. Indeed, OA is one of the most frequent disorders seen in the population. In England and Wales, between 1.3 and 1.75 million people are affected by OA, and between 0.25 and 0.5 million people have rheumatoid arthritis or inflammatory rheumatism. In France, data from a review of national health statistics during the early 1990s showed that 6 million new diagnoses of OA were being made each year. This equates to approximately 8% of the French population being diagnosed with OA. In the United States, an estimated 16% of the population, or 43 million people, had some form of arthritis in 1997. Projecting to the year 2020, an estimated 18.2% of Americans will be affected by arthritic disorders, equivalent to 60 million people.
For decades, the traditional pharmacologic management of OA has been mainly symptomatic without well-documented influence on the duration of the disease and its progression. However, during the last few years, several sets of guidelines, recommendations, or points to consider have been issued by regulatory authorities or scientific groups regarding requirements for registration of drugs to be used in the treatment of OA. The ideal outcomes include pain and function assessment for symptom-modifying drugs and joint space narrowing assessed by plain radiograph for structure-modifying compounds. Taking advantage of these more precise recommendations, several chemical entities have been investigated carefully for the management of OA. Although in several countries some of these chemical entities are available as over-the-counter or naturocetic supplements, most of the investigations performed with these molecules have not been under-taken with such products but with molecules registered and marketed as prescription drugs that have fulfilled all the requirements for quality and safety at the level of the health authorities. This article summarizes the evidence indicating that some compounds can effectively interfere with the structural progression of the disease.
Purpose of review: Several entities have been investigated carefully for the symptomatic and structural management of osteoarthritis. This review reports recent findings suggesting that such compounds may delay the structural progression of osteoarthritis.
Recent findings: The most compelling evidence of a potential for inhibiting the structural progression of osteoarthritis has been obtained with glucosamine sulfate, whereas preliminary results obtained in patients with osteoarthritis of the hands also suggest that chondroitin sulfate could be used in the same indication. At any rate, these two compounds have clearly demonstrated a symptomatic action, mainly in osteoarthritis of the lower limbs. Patients with the less severe radiographic osteoarthritis will experience, in the long run, the most dramatic disease progression in terms of joint space narrowing. Such patients may be particularly responsive to structure-modifying drugs.
Summary: Glucosamine sulfate has demonstrated its ability to reduce the progression of osteoarthritis in the lower limbs. The preliminary results obtained in the hands suggest that chondroitin sulfate could also be of interest in this indication. An important issue is that all the conclusive studies with such chemical entities resulted from the use of prescription medicines, not over-the-counter pills or food supplements.
When considering the importance of medical issues, the first factor to take into account is the prevalence of the disorder. Arthritis, specifically osteoarthritis (OA), has been shown to have a high prevalence wherever such statistics are available. Indeed, OA is one of the most frequent disorders seen in the population. In England and Wales, between 1.3 and 1.75 million people are affected by OA, and between 0.25 and 0.5 million people have rheumatoid arthritis or inflammatory rheumatism. In France, data from a review of national health statistics during the early 1990s showed that 6 million new diagnoses of OA were being made each year. This equates to approximately 8% of the French population being diagnosed with OA. In the United States, an estimated 16% of the population, or 43 million people, had some form of arthritis in 1997. Projecting to the year 2020, an estimated 18.2% of Americans will be affected by arthritic disorders, equivalent to 60 million people.
For decades, the traditional pharmacologic management of OA has been mainly symptomatic without well-documented influence on the duration of the disease and its progression. However, during the last few years, several sets of guidelines, recommendations, or points to consider have been issued by regulatory authorities or scientific groups regarding requirements for registration of drugs to be used in the treatment of OA. The ideal outcomes include pain and function assessment for symptom-modifying drugs and joint space narrowing assessed by plain radiograph for structure-modifying compounds. Taking advantage of these more precise recommendations, several chemical entities have been investigated carefully for the management of OA. Although in several countries some of these chemical entities are available as over-the-counter or naturocetic supplements, most of the investigations performed with these molecules have not been under-taken with such products but with molecules registered and marketed as prescription drugs that have fulfilled all the requirements for quality and safety at the level of the health authorities. This article summarizes the evidence indicating that some compounds can effectively interfere with the structural progression of the disease.
Source...