Generalized osteoarthritis: ways to search effective pharmacotherapy

Background. Osteoarthritis is a heterogeneous disease characterized by lesions of one or more joints, diversity of clinical features, and a large palette of biochemical and molecular characteristics, which together suggests the existence of multiple phenotypes and endotypes of osteoarthritis. In modern medicine, osteoarthritis is considered as part of a multisystem active pathologic process in the human body, triggered by a group of systemic (genetic, transcriptomic, metabolomic, proteomic, neuroimmunoendocrine) and local (biomechanical) factors. Today, osteoarthritis should be treated as a systemic disease, taking into account individual patient factors such as genetics, inflammatory response, and lifestyle.Objective. The purpose of the review of medical literature was to search for modern effective and safe therapeutic interventions for generalized osteoarthritis (GOA).Results. An analysis of the results of studies of the epidemiology of GOA, genetic characteristics and data on pheno- and endotyping of GOA was carried out. Current mechanisms of development of GOA are presented, including the role of neoangiogenesis and neoinnervation. The multimodal approach and modern directions and classification of disease-modifying therapy for GOA are considered. An analysis of the mechanisms of action, effectiveness and prospects for the use of chondroitin sulfate (CS), glucosamine sulfate (GS) and undenatured collagen (UC) type II was performed, taking into account the endotype for a specific phenotype of GOA with the development of personalized regimens therapy of OA for the parenteral form of CS.Conclusion. Therefore, GOA should be treated as a systemic disease, taking into account its genetics, inflammatory response and lifestyle, and medical care should be more holistic and personalized.