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Joint endoprosthetics is a treatment of choice for patients with decompensated osteoarthritis (OA), who have exhausted the possibilities of pharmacotherapy and other methods of conservative treatment. Preparation for endoprosthetics and rehabilitation after surgery usually includes measures to improve the muscle condition and local blood circulation in the joint area, and if necessary, pain management. The unique spectrum of anti-inflammatory effect of chondroprotectors based on chondroitin sulfate and glucosamine sulfate includes inhibition of NF-κB cascade, toll-like receptors, pro-inflammatory cytokines, metalloproteinases, and significantly alleviates the course of OA. Reducing the severity of OA is important for preparing for surgery, subsequent rehabilitation, and preventing the revision surgery.

Chronic systemic inflammation, which is significantly exacerbated by COVID-19 or in conditions of induced physical inactivity, has a great negative effect on the condition of patients with osteoarthritis (OA). Conversely, diseases associated with chronic inflammation (OA, obesity, hypercholesterolemia, bronchial asthma, diabetes mellitus, chronic kidney disease, deficiency of essential micronutrients, etc.) are the background for a more severe course of coronavirus infection. In patients with this comorbid background, infection with SARS-CoV-2 exacerbates chronic systemic inflammation through activation of the NLRP3 inflammasome with the involvement of toll receptors (TLRs). Inflammasome activation is the central mechanism for the formation of the so-called cytokine storm, which leads to pyroptosis of various cell types and the development of multiple organ pathologies characteristic of COVID-19. In addition, induced physical inactivity (immobilization stress) contributes to the development of sarcopenia and increased pain in OA. The chondroprotectors chondroitin sulfate, glucosamine sulfate, undenatured collagen inhibit TLR and inflammasome activation, inhibit muscle mass loss, and may exhibit a direct antiviral effect (inhibit the replication of the SARS-CoV-2 virus).

Background. The complex mechanisms of action of chondroitin sulfate (CS) and glucosamine sulfate (GS) at the molecular level make it possible to assert the applicability of the corresponding drugs far beyond chondroprotection. Inhibition of proinflammatory mechanisms (NF-κB, activation of toll-receptors, increased levels of cytokines, degranulation of mast cells, etc.) by CS and GS provide the prospects for their use to inhibit inflammation in the respiratory tracts, allergic processes and to enhance the effects of glucocorticoids.Objective: to systemize data on the effects of chondroitin sulfate and glucosamine sulfate on pathophysiological processes in pulmonary pathology.Material and methods. Using the methods of the theory of text topological analysis an intellectual analysis of 1273 publications on fundamental and clinical studies of the relationship of CS and GS with lung function was carried out. The search was performed by a key query “(glucosamine OR chondroitin) AND (lung OR lungs OR pulmonary OR pulmonology)” in the Pubmed/MEDLINE database. As a result, 59 informative biomedical terms were identified.Results. The chemoproteomic study of CS and GS showed that their intake promoted an increase in the expression of 19 antitumor proteins and a decrease in the expression of 25 pro-inflammatory proteins involved in lung function. CS and GS can be used in the complex therapy of infectious diseases of the lungs, with fibrotic changes in the respiratory tracts and, as well, help to reduce the risk of neoplastic diseases of the lungs.Conclusion. The results of this analysis allow us to assert the promising nature of the use of CS and GS in several neoplastic diseases of the lungs, as well as the high safety of drugs based on pharmaceutical standardized forms of CS and GS in terms of lung function.

The literature was reviewed for reports on the pathogenesis, diagnosis and treatment of injuries to the posterior cruciate ligament (PCL). PCL is the largest intra-articular ligament in the knee joint and has good tensile mechanical properties. Optimal diagnosis and appropriate treatment strategies for PCL injury are discussed. Nonoperative treatment of isolated PCL injuries is associated with a significant risk of degeneration of the knee structures and impaired function. A comprehensive line of PCL reconstruction options are offered for the surgical approach to PCL reconstruction to restore functional joint stability in the knee. Literature data on protective effect of glucosamine, chondroitin sulfate in the prevention of secondary knee osteoarthritis caused by PCL ruptures were reviewed.

Objective: to carry out a systems analysis of the molecular mechanisms of action of the chondroprotector Sustaguard® Arthro based on the microcrystalline pharmaceutical substance glucosamine sulfate (GS) manufactured by Bioiberica S.A.U. (Spain). Material and methods. The systems analysis of the molecular mechanisms was based on literature data and proteomic databases through machine learning systems. Results and discussion. GS interacts with the receptors CD44, TLR4, and ICAM1 on the surface of chondrocytes, inhibits the proinflammatory transcription factor NF-κB and the cytokine signaling pathway JAK/STAT, and regulates the synthesis of IgA, the migration of leukocytes, and the activity of hematopoietin and interferon receptors. Conclusion. The findings indicate that there are molecular mechanisms of synergism between glucosamine and nonsteroidal anti-inflammatory drugs in the therapy of cartilage tissue pathology.

The reasonability of using nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis (OA) is due mainly to persistent articular tissue inflammation that contributes to the progression of structural changes in the hyaline cartilage, as well as its leading clinical manifestation – pain syndrome caused by damage to different articular structures. NSAIDs are basic rapid-acting symptom-modifying drugs in the treatment of OA. Meloxicam has high anti-inflammatory and analgesic activities. The effect of meloxicam on hyaline cartilage metabolism permits one to consider it as a potential chondroprotective agent. Short- and long-term investigations have demonstrated its good tolerability, including that in patients with polymorbidity. The use of meloxicam does not increase the risk of cardiac and renal complications. The high therapeutic activity of meloxicam along with the low level of adverse reactions determines the pharmacoeconomic expediency of its use.