Use of Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: a Sight Through the Prism of Pathogenesis
The article discusses the epidemiology, pathogenesis and treatment of osteoarthritis, the most common disease of the musculoskeletal system. According to numerous studies, the development of the disease is accompanied by the increase in the synthesis of a number of pro-inflammatory mediators and growth factors, such as interleukins 1, 6, 8, 15, tumor necrosis factor alpha, transforming growth factor beta 1, which support inflammation and contribute to the development of catabolic processes in articular cartilage and subchondral bone. The significant role of inflammation in the disease development justifies pathogenetically the use of nonsteroidal anti-inflammatory drugs. It is stressed that many years of application experience, as well as the results of randomized clinical trials and meta-analysis data, indicate high efficiency of aceclofenac, according to which the drug is not inferior to both: non-selective nonsteroidal anti-inflammatory drugs, including diclofenac, and selective inhibitors of cyclooxygenase 2. It significantly reduces the intensity of pain and improves the functional state of the joints in patients with osteoarthritis of different localization. With significant suppression of cyclooxygenase 2 (97%), the drug reduces the expression of cyclooxygenase 1 by only 46%, which explains its good profile of gastrointestinal tolerability. In addition, aceclofenac inhibits the synthesis of key inflammatory cytokines - interleukins 1-beta and tumor necrosis factor alpha, expresses cell adhesion molecules (L-selectin), and stimulates the synthesis of interleukin 1-beta receptor antagonist in chondrocytes. The important advantage of aceclofenac is the absence of negative effect on the metabolism of articular cartilage. Taken in account these data, aceclofenac appears to be one of the most popular drugs in patients with osteoarthritis in need of anti-inflammatory therapy.