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The article deals with the various types of vertebrogenic and musculoskeletal pain syndromes. Special attention is paid to the place of structure-modifying agents in the complex of treatment for chronic pain syndrome in these patients, as well as the impact on the psychological components of pain syndrome, including depression and anxiety., Статья посвящена различным видам вертеброгенных и мышечно-скелетных болевых синдромов. Особое внимание уделяется месту структурно-модифицирующих препаратов в комплексе лечения хронического болевого синдрома у данной категории больных, а также воздействию на психологические компоненты болевого синдрома, включая депрессию и тревогу., Стаття присвячена різним видам вертеброгенних і м’язово-скелетних больових синдромів. Особлива увага приділяється місцю структурно-модифікуючих препаратів у комплексі лікування хронічного больового синдрому в даної категорії хворих, а також впливу на психологічні компоненти больового синдрому, включаючи депресію і тривогу.

Остеоартрит є захворюванням з високим індексом коморбідності. Відзначається, що наявність хронічного больового синдрому при остеоартриті є важливим фактором ризику більш тяжкого перебігу супутніх захворювань, зокрема серцево-судинних. Остеоартрит асоційований з підвищеним ризиком смертності, а основними факторами ризику є вік, тяжкість захворювання, вираженість больового синдрому і наявність поліморбідних станів. Вибір препарату симптом-модифікуючої уповільненої дії становить певні труднощі, оскільки поряд з ефективністю він повинен бути безпечним у поліморбідних кардіологічних і ендокринологічних пацієнтів, не вступати в фармакологічні взаємодії з призначеною терапією, а також по можливості проявляти додаткові позитивні властивості щодо ліпідного і вуглеводного обмінів. Серед препаратів, що мають знеболюючий ефект при остеоартриті, чинять патогенетичну дію і позитивно впливають на перебіг окремих компонентів поліморбідності, можна виділити препарат неомилюваних сполук авокадо і сої Піаскледин 300. Подано клінічні випадки ефективного застосування Піаскледину у коморбідних пацієнтів з остеоартритом.

Analysis of the results of clinical trials should be based on the use of objective parameters that allow for assessing the significance of the data obtained for real medical practice. These parameters include Minimal Clinically Important Improvement (MCII) and Patient Acceptable Symptom State (PASS).Objective: to determine the approximate value of the parameters MCII and PASS on the basis of data from the PARACELS (Regular Piascledine and Artrosilene Administration for osteoarthritis (OA): Expediency of the Unified Treatment Regimen) study.Patients and methods. A study group consisted of 6,448 patients (70.9% female, 29.1% male) (mean age, 57.8±10.2 years) with knee OA and moderate or severe pain of ≥40 mm on a 100-mm visual analogue scale (VAS). All the patients took during 12 weeks avocado/soybean unsaponifiables 300 mg/day and a nonsteroidal anti-inflammatory drug (ketoprofen lysine salt) 320 mg/day, which was prescribed at the beginning of treatment for 10–14 days and then could be used on demand with more pain to come. Pain intensity was measured using the 100-mm VAS. Patient satisfaction with treatment results was also studied with a point scale, where 0 is worsening or no effect, while 5 is an excellent effect. The dynamics of pain was compared and treatment results were assessed by patients.Results and discussion. After 12 weeks, most patients showed a substantial improvement: a mean pain intensity reduction of 77.7±29.6%. A satisfactory treatment result estimate (that can be considered as a surrogate measure of MCII) corresponded to an average pain reduction of 32.0±11.7 mm on VAS (a 47.3% improvement compared to the baseline level). A good treatment result estimate (that can be considered as a surrogate measure of PASS) corresponded to an average pain reduction of 41.0±13.3 mm on VAS (a 62.9% improvement compared to the baseline level).Conclusion. The PARACELS study has shown that in Russian patients receiving analgesic therapy, MCII can correspond to a pain reduction of >30 mm on VAS (>40% of the baseline level), PASS can do to its reduction of >40 mm on VAS (>60% of the baseline level).

Background Osteoarthritis (OA), though being treated via various methods and medicines, is still a major healthcare concern mostly due to the increase in diagnosis of these age-related diseases. The present study aimed at investigating the effects of oral and intra articular injection of grape seed oil on OA in male rat models. Methods and materials Seventy male rats were selected and their anterior cruciate ligament was cut to induce OA. They were divided into 7 groups (n = 10): C1, no treatment; C2, receiving 300 mg/day of Piascledine per os (PO); C3, 1 mg sodium hyaluronate intra-articularly in days 1, 7, 14; C4, 1 mg methyl-prednisolone acetate intra-articularly; E1, avocado and grape seed oil combination (2:1, 300 mg/day) PO; E2, 500 mg/day of grape seed oil PO; E3, 200 mg/day grape seed oil intra-articularly. After 10 weeks, the rats were anesthetized and evaluated radiologically and histopathologically. P value ≤ 0.05 was considered as statistically significant. Results All the groups made significant differences with C1 regarding all inspected radiological criteria (P ≤ 0.05). E1 and E3 showed significantly better effects on medial femoral condyle, medial tibial condyle, joint space width, total osteophyte, and OA scores (P ≤ 0.04). Joint surface, matrix, cell distribution, cell population viability, calcification, and subchondral bone in treatment groups had significantly better scores versus C1 (P ≤ 0.04). E1 and E3 had significantly superior results regarding joint surface, cell viability, and calcification (P ≤ 0.04). Conclusions Grape seed oil has protective effects, both in injectable form and PO in combination with avocado, on OA in rats. Further clinical trials are necessary.

The main goal of management of patients with osteoarthritis (OA) is analgesic and anti-inflammatory therapy, deceleration of the progression of the disease, and improvement of quality of life. Fast-acting symptomatic drugs (analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs)) and sustained-release structure-modifying drugs (chondroitin sulfate, glucosamine sulfate, their combination, piascledine, diacerein) are used to treat OA. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)) has analyzed the proposals of a number of expert groups and elaborated a consensus on the management of patients with OA: it has recommended the use of sustained-release drugs just in early OA. The article gives the data of comparative studies of a new Russian chondroprotector, the active ingredient of which is a bioactive extract from small sea fish, which contains alflutop. It evaluates the analgesic and anti-inflammatory effects and acute and chronic toxicity on experimental animal models and the preliminary results of therapy with the new drug in patients with OA in the large and small joints.

Background Exogenous lipoid pneumonia is a rare disease resulting from intra-alveolar accumulation of lipids of mineral, vegetal, or animal origin, that induce a foreign body type of inflammatory reaction in the lungs. Gastroesophageal reflux disease and other esophageal abnormalities have often been associated with this disease. Case presentation We herein report the case of an 83-year-old patient in whom a follow-up chest computed tomography scan, for a lingular consolidation, showed multifocal ground glass and consolidative opacities with areas of low attenuation, suggestive of exogenous lipid pneumonia. The patient had been on piascledine capsules (avocado/soybean unsaponifiables) for 20 years and had a hiatal hernia with documented gastroesophageal reflux disease. After thorough history taking, no other predisposing factors were found. The diagnosis was confirmed using oil red staining of bronchoalveolar lavage showing lipid-laden macrophages and extracellular lipid droplets. Conclusions To our knowledge, this is the first case of ELP secondary to avocado/soybean unsaponifiables in the literature.

Background: Hot flashes are the most common symptoms experienced by women around the time of menopause. Many women are interested in herbal medicines because of fear of side effects of hormone therapy. Objective: The aim of this systematic review was to assess the effectiveness of Iranian herbal medicines in alleviating hot flashes. Materials and Methods: MEDLINE (1966 to January 2015), Scopus (1996 to January 2015), and Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2015) were searched along with, SID, Iran Medex, Magiran, Medlib and Irandoc. Nineteen randomized controlled trials met the inclusion criteria. Results: Overall, studies showed that Anise (Pimpinella anisum), licorice (Glycyrrhizaglabra), Soy, Black cohosh, Red clover, Evening primrose, Flaxseed, Salvia officinalis, Passiflora، itex Agnus Castus, Piascledine (Avacado plus soybean oil), St. John's wort (Hypericum perforatum), and valerian can alleviate the side effects of hot flashes. Conclusion: This research demonstrated the efficacy of herbal medicines in alleviating hot flashes, which are embraced both with people and health providers of Iran Therefore, herbal medicine can be seen as an alternative treatment for women experiencing hot flashes.

У статті наведені дані літератури та результати власного спостереження щодо ефективності та безпечності препарату Піаскледин. У дослідження включили 20 жінок (середній вік 58,90 ± 7,36 року, зріст 164,60 ± 5,26 см, вага 80,40 ± 12,94 кг, ІМТ 29,8 ± 1,4). Дизайн дослідження включав огляд хворих та анкетування на початку лікування, через 1, 3 та 5 міс. прийому Піаскледину. Піаскледин призначали по 1 капсулі 300 мг один раз на добу протягом 5 міс. Після завершення курсу лікування відмітили вірогідне зменшення больового синдрому як у спокої (62,60 ± 14,06 проти 43,70 ± 19,23; р < 0,05), так і під час руху (77,70 ± 11,65 проти 58,50 ± 14,84; р < 0,05), тривалості ранкової скутості (19,5 ± 11,57 проти 14,30 ± 5,85; р < 0,05) та її інтенсивності (59,1 ± 21,8 проти 45,40 ± 21,12; р < 0,05), зниження сумарного індексу WOMAC через 3 міс. (1259,7 ± 316,7 проти 1028,7 ± 381,7; р < 0,05) та 5 міс. (1031,4 ± 336,9; р < 0,05) прийому Піаскледину. Загалом відмітили зменшення потреби в нестероїдних протизапальних препаратах, високий комплайєнс хворих, безпечність та ефективність препарату Піаскледин у лікуванні остеоартрозу колінних суглобів, що сприяє зменшенню вираженості больового синдрому та покращанню функціональної активності в пацієнтів.

Objective(s): The aim of this study was to compare the chondrogenic induction potential of Piascledine and TGF-β1 on adipose-derived stem cells (ADSCs) in fibrin and fibrin-alginate scaffolds. Materials and Methods: Human subcutaneous adipose tissues were harvested from three patients who were scheduled to undergo liposuction. Isolated ADSCs were proliferated in a culture medium. Then, the cells were seeded in fibrin or fibrin-alginate scaffolds and cultured for 14 days in a chondrogenic medium containing Piascledine, TGF-β1, or both. The rate of cell proliferation and survival was evaluated by using MTT [3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide] assay and the rate of the expression of type II collagen, aggrecan, and type X collagen genes was evaluated by real-time polymerase chain reaction (real-time PCR) method. Results: The MTT results showed that Piascledine is able to enhance the proliferation and survival of ADSCs in fibrin scaffolds in comparison to other groups (P

Introduction: Menopause is one of the natural stages of women’s life usually begins in 45-55 y old. The most common symptom is hot flushes. The aim of this study is to evaluate the effect of different doses of piascledine on hot flashes of post-menopausal women. Method: 69 postmenopausal women referred to Dr. Rasekh clinic was entered to the study and were randomly divided into 3 groups, first group; 300 mg piascledine daily, second group; 300 mg piascledine twice a day and third group; hormone replacement therapy (1.25 mg conjugated estrogen for 25 d and 10 mg dydrogestrone for 15 d). Hot flushing symptoms were evaluated before and after intervention using Blatt-Kupperman Menopausal Index (BKMI). The data were analysed by SPSS 21 software. Result: BKMI had a reduction of 17.91 in first group, 20.9 in second group and 20.96 in third group. Conclusion: We found that a higher dosage of piascledine leads to a significant reduction in hot flushes rate and according to the effectiveness and also lack of side effects related to the higher dose of piascledine, it seems to be an appropriate alternative for hormone replacement therapy to treat the menopausal symptoms in high dosage.

We investigated the therapeutic effects of an extract of Psidium guajava (guava) leaf on experimentally induced osteoarthritis in guinea pig. The left knee of 30 male guinea pigs was anesthetized and the cranial cruciate ligament was severed. The animals were followed for 8 weeks until osteoarthritis was confirmed by radiography and histopathology. Animals were divided randomly into five groups; group 1, the ligament was severed and untreated; group 2, the ligament was severed and treated with piascledine, an extract of soybean and avocado; group 3, the ligament was severed and treated with 200 mg/kg hydroethanolic extract of guava; group 4, the ligament was severed and treated with 400 mg/kg hydroethanolic extract of guava; and group 5, control animals without surgery or extracts. Radiological and histopathological evaluations after 8 weeks showed reduced severity of osteoarthritis in the piascledine treatment group compared to group 1. The guava extract also reduce the severity of osteoarthritis compared to controls. Histopathological examination of treatment and control groups showed that treatment the guava extract improved lesions significantly. Hydroethanolic extracts of guava leaf appears to prevent osteoarthritis by inhibition of free radical formation in the knee joint.

Objective To assess the ability of avocado–soybean unsaponifiable—Expanscience (ASU-E) to slow radiographic progression in symptomatic hip osteoarthritis (OA). Methods Prospective, randomised, double blind, parallel group, placebo controlled 3 year trial. Patients with symptomatic (painful ≥1 year, Lequesne Index between 3 and 10) hip OA (American College of Rheumatology criteria) and a minimum joint space width (JSW) of the target hip between 1 and 4 mm on a pelvic radiograph were randomly assigned to 300 mg/day ASU-E or placebo. Standing pelvis, target hip anteroposterior (AP) and oblique views were taken annually. The primary outcome was JSW change at year 3, measured at the narrowest point on pelvic or target hip AP view (manual measure using a 0.1 mm graduated magnifying glass). The full analysis dataset (FAS) included all patients having at least two successive radiographs. An analysis of covariance Mixed Model for Repeated Measurements with Missing at Random (for missing data) was performed to compare adjusted 3 year JSW changes (primary outcome) and the percentages of ‘progressors’ (JSW loss≥0.5 mm) between groups. Results 399 patients were randomised (345 kept in the FAS), aged 62 (35–84) years, 54% women, mean body mass index 27 (SD 4) kg/m 2 , mean symptom duration 4 (SD 5) years, 0–100 normalised Lequesne Index 30 (SD 9) and global pain visual analogue scale 37 (SD 23) mm. Mean baseline JSW was 2.8 (0.9) mm. There was no significant difference on mean JSW loss (−0.638 mm vs −0.672 mm, p=0.72, in the ASU-E and placebo groups, respectively) but there were 20% less progressors in the ASU-E than in the placebo group (40% vs 50%, respectively, p=0.040). No difference was observed on clinical outcomes. Safety was excellent. Conclusions 3 year treatment with ASU-E reduces the percentage of JSW progressors, indicating a potential structure modifying effect in hip OA to be confirmed, and the clinical relevance requires further assessment. Trial registration number on ClinicalTrial.gov NCT01062737

The article presents a study on the relationship and the dynamics of indicators of insulin resistance and systemic inflammation in patients with osteoarthrosis and obesity and the efficiency of using in them symptomatic slow-acting drug based on avocado and soybean unsaponifiables — Piascledine. Symptom-modifying Piascledine effect has been shown, it consists in significant decrease of pain severity both during physical activity and at rest in patients of the main group on the background of improved functional state of the joints. In this case, the initial manifestations of the analgesic effect of the drug against the articular syndrome were registered from the second month of treatment. It was stressed that obesity is a factor that slows down the development of analgesic effect., В статье представлено исследование, посвященное изучению взаимосвязи и динамики показателей инсулинорезистентности и системного воспаления у пациентов с остеоартрозом и ожирением и эффективности использования у них симптоматического препарата замедленного действия на основе неомыляемых соединений масел авокадо и сои Пиаскледин. Продемонстрирован симптом-модифицирующий эффект Пиаскледина, заключающийся в достоверном снижении выраженности боли как при физической нагрузке, так и в покое среди пациентов основной группы на фоне улучшения функционального состояния суставов. При этом начальные проявления обезболивающего действия препарата в отношении суставного синдрома зарегистрированы начиная со второго месяца лечения. Подчеркнуто, что ожирение является фактором, замедляющим развитие анальгетического эффекта., У статті наведено дослідження, присвячене вивченню взаємозв’язку і динаміки показників інсулінорезистентності та системного запалення в пацієнтів з остеоартрозом і ожирінням і ефективності використання в них симптоматичного препарату уповільненої дії на основі неомильних сполук масел авокадо та сої Піаскледин. Продемонстровано симптом-модифікуючий ефект Піаскледину, що полягає в вірогідному зниженні вираженості болю як при фізичному навантаженні, так і в спокої серед пацієнтів основної групи на тлі поліпшення функціонального стану суглобів. До того ж початкові прояви знеболюючої дії препарату щодо суглобового синдрому зареєстровані починаючи з другого місяця лікування. Підкреслено, що ожиріння є фактором, що сповільнює розвиток анальгетичного ефекту.

Osteoarthritis is nowadays considered not as a degenerative process but as a pathological remodeling of various tissues of a joint (bone, cartilaginous and synovial tissue) that is associated with and determined by pro-inflammatory mediators with further development of metabolic and functional dysfunction of all joint structures. Interleukin 1 plays a particular role in the pathogenesis of osteoarthritis. It affects metabolism of articular cartilage and sunchondral bone in different ways. The family of transforming growth factors also plays an important role, namely transforming growth factor β. That is why they are important targets for therapeutic strategy in osteoarthritis. Discovery of molecular mechanisms of cartilage degradation and detailing of the reasons of persistent inflammation in joint tissues led to the development of the agents with symptoms and structure modifying properties that affect the course and rate of progression of the disease. According to ЕULAR 2003 recommendations only 5 agents have symptom modifying action, particularly chondroitin sulfate, glucosamine sulphate, diacerein, hyaluronic acid and Piascledine. The last agent is of great interest due to its anticytolytic action. The paper deals with the experimental proves for positive effects of Piascledine on the concentration of pro-inflammatory cytokines as well as the results of clinical studies of high efficiency of the agent with symptoms and structure modifying properties for the treatment of osteoarthritis., Остеоартрит сегодня рассматривается не как дегенеративный процесс, а как патологическое ремоделирование различных тканей сустава (костной, хрящевой, синовиальной), которое инициируется и определяется провоспалительными медиаторами с развитием метаболической, а позже и функциональной дисфункции всех суставных структур. Особая роль в патогенезе остеоартрита принадлежит интерлейкину-1, который характеризуется разноплановым влиянием на метаболизм суставного хряща и субхондральной кости, а также семье трансформирующих факторов роста, в частности трансформирующему фактору роста β. Это делает их важной мишенью терапевтической стратегии при остеоартрите. Раскрытие молекулярных механизмов деградации хряща и уточнение причин, ведущих к персистирующему воспалению непосредственно в тканях сустава, послужило основанием для разработки не только симптомо-, но и структурно-модифицирующих препаратов, активно влияющих на течение и темпы дальнейшего прогрессирования заболевания. Согласно рекомендациям ЕULAR 2003 года, только 5 препаратов имеют симптомомодифицирующие свойства, а именно хондроитина сульфат, глюкозамина сульфат, диацереин, гиалуроновая кислота, а также препарат Пиаскледин. Последний препарат представляет большой интерес благодаря существенной антицитокиновой активности. В статье представлены экспериментальные доказательства положительного влияния препарата Пиаскледин на концентрацию провоспалительных цитокинов, а также результаты клинических исследований по высокой эффективности как симптомо-, так и структурно-модифицирующего препарата в лечении остеоартрита., Остеоартрит сьогодні розглядається не як дегенеративний процес, а як патологічне ремоделювання різних тканин суглоба (кісткової, хрящової, синовіальної), що ініціюється і визначається прозапальними медіаторами з розвитком метаболічної, а пізніше й функціональної дисфункції всіх суглобових структур. Особлива роль у патогенезі остеоартриту належить інтерлейкіну-1, що характеризується різноплановим впливом на метаболізм суглобового хряща і субхондральної кістки, а також родині трансформуючих факторів росту, зокрема трансформуючому фактору росту β. Це робить їх важливою мішенню терапевтичної стратегії при остеоартриті. Розкриття молекулярних механізмів деградації хряща та уточнення причин, що ведуть до персистуючого запалення безпосередньо в тканинах суглоба, послужило підставою для розробки не тільки симптомо-, але й структурно-модифікуючих препаратів, що активно впливають на перебіг і темпи подальшого прогресування захворювання. Згідно з рекомендаціями ЕULAR 2003 року, тільки 5 препаратів мають симптомомодифікуючі властивості, а саме хондроїтину сульфат, глюкозаміну сульфат, діацереїн, гіалуронова кислота, а також препарату Піаскледин. Останній препарат становить неабиякий інтерес завдяки суттєвій антицитокіновій активності. У статті наведені експериментальні докази позитивного впливу препарату Піаскледин на концентрацію прозапальних цитокінів, а також результати клінічних досліджень щодо високої ефективності як симптомо-, так і структурно-модифікуючого препарату в лікуванні остеоартриту.

To investigate that a 6-month treatment with avocado soybean unsaponifiable (Piascledine® 300 mg) once daily is as effective as with chondroitin sulfate 400 mg three times daily in femorotibial gonarthrosis, and also the carry-over effect for two more months is comparable. Patients were randomized (1:1) to the treatment groups. They received for 6 months 3 capsules chondroitin sulfate per day or one capsule of avocado soybean unsaponifiable (ASU) in a double-dummy technique. A 2-month post-treatment period followed to determine the carry-over effect. Primary efficacy criterion was the change of the WOMAC-index from study begin to end of treatment. Secondary criteria were the changes in Lequesne-index, pain on active movement and at rest, global assessment of efficacy. Three hundred sixty-four patients have been taken up into the trial. Three hundred sixty one patients were eligible for evaluation. One hundred eighty three received ASU 300 mg once daily, one hundred seventy eight chondroitin sulfate three times daily. The WOMAC-index decreased in both groups for approx. 50% to the end of therapy. During the post-treatment observation there was a further slight improvement. There was no statistical significant difference between the treatment groups during the entire observation. All other observed parameters showed the same pattern. The daily intake of rescue medication was reduced continuously. Overall efficacy has been rated excellent and good in more than 80% of the patients in both groups. Both drugs were safe and well tolerated. The first direct comparison between avocado soybean unsaponifiable 300 mg once daily and chondroitin sulfate three times daily reveiled no difference in efficacy or safety aspects between 1 capsule ASU 300 mg per day and 3 capsules chondroitin sulfate per day. It can be assumed that the once daily intake of ASU will lead to a better compliance in routine therapy.

In rheumatoid arthritis (RA), hypertrophy of the synovial membrane generates a tumour-like pannus that invades the joint cavity and erodes cartilage and bone. Invasion of the extracellular matrix (ECM) is accompanied by angiogenesis, in which vascular endothelial growth factor (VEGF) and tissue inhibitors of metalloproteinases (TIMPs), produced by synoviocytes lining the pannus, have a primary role. Piascledine (PSD) is used in the treatment of osteoarthritis and has anti-inflammatory effects in vitro.To study the effects of PSD on levels of VEGF and TIMP-1 and chemoinvasion in RA synoviocytes and healthy controls.The effects of PSD 5, 10, and 20 microg/mL were evaluated, with/without interleukin-1beta (IL-1beta) and tumour necrosis factor-alpha (TNFalpha) 20 ng/mL, on synoviocytes. The levels of VEGF and TIMP-1 were assayed in the culture medium by enzyme-linked immunosorbent assay (ELISA). Chemoinvasion was measured by the Boyden chamber invasion assay.RA synoviocytes treated with PSD showed, compared to basal, lower levels of VEGF (41080+/-830 vs. 79210+/-920 pg/106 cells, p0.001) and increased levels of TIMP-1 (23540+/-93.2 vs. 12860+/-42.9 ng/106 cells, p0.001). PSD decreased dose-dependently IL-1beta and TNFalpha induced migration.In RA synoviocytes, and also to a lesser extent in control cells, PSD modulates VEGF and TIMP-1 and decreases chemoinvasion. PSD might have a role in the treatment of RA synovitis controlling invasiveness.

Laboratoires EXPANSCIENCE have discovered, devel- oped and produced a pharmaceutical product, PIASCLE- DINE � 300, which is effective for the ''symptomatic, delayed-effect treatment of arthrosis of the hip and knee'' (wording from the MA indication). The active principle of this pharmaceutical product is called ASU EXPAN- SCIENCEand is composed of a mixture of soybean unsaponifiables and specific avocado unsaponifiables. The specificities of the product and elements of the process are protected by patents. Recently, Au RY et al. have demonstrated that a so called ASU extract, named ASU-NMX 1000TM (Nutramax Labora- tories Inc, Edgewood, MD, USA), suppressed tumour ne- crosis factor (TNF)-a, IL-1b, cyclooxygenase (COX)-2 and iNOS gene expression, and PGE2 and nitric oxide produc- tion in articular chondrocytes and monocyte/macrophages 1 . In the introduction, following a brief point on arthrosis, the mediators involved and the usual treatments (NSAIDs) prescribed for treating this pathology, the authors propose the use of avocado and soybean unsaponifiables (ASU) as an alternative or additional therapeutic approach. To make their case, the authors list and describe several clinical, animal and in vitro studies demonstrating the phar- macological and clinical efficacy of ASU. We must draw your attention to the fact that the ASU used and tested in all of the studies referred to in the text are strictly original and unique ASU EXPANSCIENCEe active ingredient of the patented pharmaceutical product PIASCLEDINE � 300 from Laboratoires EXPANSCIENCE

An open-labeled randomized study of the efficacy and safety of Piascledine-300 in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) versus the latter was conducted in 2 matched groups of patients with lower back pain associated with spondylarthrosis. During combined therapy using Piascledine, there was a reduction in the pain syndrome particularly with the longer administration of the drug. The use of Piascledine in spondylarthrosis showed its clinical efficacy in 89,2% of patients: the indices of lumbago substantially reduced and spinal function improved, which was associated with the good tolerability of the drug.