Konservative Therapie der Arthrose

Benzo[d]isothiazol-3-yl-benzamidines: a Class of Protective Agents on Culture of Human Cartilage and Chondrocytes Stimulated by IL-1β

New derivatives of N-benzo[d]isothiazol-3-yl-benzamidine 6 a were synthesized as nonacidic anti-inflammatory/antidegenerative agents. We investigated the influence of the amidines 6 a-j on the production of NO, PGE(2), MMP-3, COX-2, ROS, and GAGs, key molecules involved in cartilage destruction in osteoarthritic diseases. The antidegenerative properties of the novel designed derivatives 6 b-j were improved with respect to N-benzo[d]isothiazol-3-yl-benzamidine 6 a. All of the compounds 6 a-j promoted the reduction of most of the IL-1beta-induced harmful effects. Derivatives 6 d, 6 h, and 6 j were the most potent of all the tested compounds, particularly in the human chondrocyte culture model.

Crushed bone grafts and a collagen membrane are not suitable for enhancing cartilage quality in the regeneration of osteochondral defects—An in vivo study in sheep

Hyaline joint cartilage has only a limited potential for self-repair. Some of the published techniques for osteochondral defect therapy try to improve that potential. In this study, it was hypothesised that one of those surgical techniques, the crushed transplanted bone graft together with a collagen membrane, accelerates significantly the reconstruction of the subchondral bone plate and improves the mechanical and histological quality of repaired cartilage in osteochondral defects compared to an empty control defect. In order to test this hypothesis, defects were created in the left knee of 12 sheep and filled either with autologous crushed bone graft or left empty. The animals were sacrificed after 3 (n = 6) and 6 (n = 6) months. No differences were found either macroscopically or histomorphometrically between the bone graft and empty control defects. The biomechanical as well as the histological results of the bone graft defects were inferior to the control defects with inflammatory processes caused either by bone graft or membrane remnants. Based on the results in this sheep model, the filling of subchondral bone defects with compacted cancellous bone should be carefully reconsidered.

[Pharmacological treatment of osteoarthritis in the elderly]

Osteoarthritis (OA) is the most common cause of functional disability in the elderly. Pain and loss of motion induce a vicious circle, leading to instability, frailty and ultimately invalidity. Currently, there is no treatment to reverse or slow the disease progression to a clinically meaningful extent. Thus, the primary goal of OA treatment in the elderly is pain relief and preservation of joint function. For this, pharmacological, non-pharmacological and if necessary surgical treatment regimes must form an integrated concept. However, the real challenge is polymorbidity and other age-related or age-associated factors, which influence the course of disease and its therapy unfavorably. The changes in pharmacokinetics and -dynamics in the elderly can be compensated for the nonopioid and opioid-analgesics by the well known "start low, go slow" approach. More problematic are non-steroidal anti-inflammatory drugs (NSAIDs), which are most often used for symptomatic treatment of OA: Patients over 65 have an enhanced susceptibility to the gastrointestinal and renal side effects of NSAIDs; all NSAIDs, not only coxibs, increase the cardiovascular risk in patients with such a disease; number and severity of drug interactions is elevated due to age-associated polypharmacy. Thus, NSAIDs, including coxibs, should be used with great caution for treatment of OA in the elderly.