OSTEOARTHRITIS AND CLUSTER OF GASTROINTESTINAL COMORBID DISEASES: AGE AND GENDER PATHOGENETIC ASPECTS OF DEVELOPMENT AND INFLUENCE ON THE RESULTS OF ANTIRHEUMATIC THERAPY (LITERATURE REVIEW)
Summary. Among comorbid diseases in patients with osteoarthritis (OA), the cluster of gastrointestinal diseases is very common. It limits the usage of nonsteroidal anti-inflammatory drugs (NSAIDs) because of the development of NSAIDs — gastroduodenal- and enteropathies in treatment complexes. Nowadays, the pathogenetic role of these lesions in the development and progression of OA and the possibility of reducing the effectiveness of SYSADOAs is still unclear. The aim: to highlight the latest studies of the pathogenetic relationships of OA and comorbid lesions of the digestive system and substantiate on this basis new approaches to improve the effectiveness of comprehensive treatment of patients with such combined pathology. Materials and methods. The scientific search in printed and electronic editions, scientific search databases with the use of methods of analysis, comparison and generalization of information data is carried out. Results. The literature data on the peculiarities of the formation of NSAID enteropathies, the role of intestinal microbiome disorders in this process are highlighted. Clinical and experimental data about the role of intestinal microbiome disorders in the development of concomitant OA, obesity, non-alcoholic liver disease, low-level systemic inflammation, metabolic disorders that indirectly affect the functional state of the musculoskeletal system, including OA, osteoporosis, and cardiovascular disease systems and CNS. It is seen that the use of pre- and probiotics in the complex treatment of patients with OA is a new strategy to improve the treatment process. From their own experience, the authors note the age-related growth of the cluster of gastrointestinal diseases (duration, severity, systematicity, especially with the advent of enteropathies) and their importance in the progressive decline in the effectiveness of classical chondroprotective therapy. One of the ways out of this situation the authors see the usage in such patients of the latest phytochondroprotective agents, plant factors which favorably affect the regression of clinical manifestations of this cluster, inflammatory phenomena (local and systemic), digestive and absorption processes, including chondroprotectors, and indirectly contribute to microbiome normalization. Conclusions. Evidence has been obtained that intestinal dysbiosis is a latent, additional, pathogenetic factor in the progression of osteoarthritis, gastrointestinal and other comorbid diseases with osteoarthritis and limiting the implementation, reducing the effectiveness of comprehensive treatment of osteoarthritis. Correction of dysbiosis and aggravated lesions of the musculoskeletal system and digestive organs is considered a promising strategy for the treatment of such a complex of diseases. The use of phytochondroprotective agents containing plant factors, influencing the damage to the digestive system, is considered as one of the ways to implement such a strategy.
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