eOCaAieaeEau

uUUAIUE‚IOOU? O?AO?U iA?UIAIO
U ·OI?I?? O OOUAO?U?OAOI IOIAII??
E UAO·A?AII?? OUOU‚O‚
(OUI??UOA ?IOIEAE?O‚IIOA EOOIAO‚IEA)
a.a. AAIA‚OIAIOI?, .I.I. a.a. AIAIOAA‚, O.a. aE?A‚
e?OUAOOO?
Ei aIOUEUUU ?A‚IUOIO„EE eAac, aOOI‚
unieay ?ani?ino?aiaiiinou inoaia?o?ica (IA) e oiaiuoaou aeoeaiinou eaeeioeoa?iie yeanoacu, eieea-
A naycaiiua n yoei caaieaaaieai i?iaeaiu eiaaee- aaiacu e aaa?aeaiacu, iiaaaeyou EE–1–noeioee?iaai-
aecaoee ??acau?aeii aeooaeuiu aey ?innee. ?enei ia- iue neioac i?inoaaeaiaeiia oea?iaeanoaie [8–12]. A oi
oeaioia n IA ninoaaeyao a iaoae no?aia ieiei ?a a?aiy eia?ony iaeioi?ua i?eioeieaeuiua ?acee-
10–12% ianaeaiey, i?eia?ii o?aou ec ieo eiaao oo eee ?ey, eana?ueany, a ia?ao? i?a?aau, aicaaenoaey ia
eio? noaiaiu iao?oainiiniaiinoe, a nayce n ?ai naia- noaoiia?aeuio? einou e neiiaeaeuio? iaiei?eo. N?eoa-
a?aiaiii ia?aoia e yooaeoeaiia ea?aiea eiaao aieu- aony, ?oi niiniaiinou ii?iaeeciaaou einoiue iaiai
oia nioeaeuiia e yeiiiie?aneia cia?aiea. naienoaaiia ON, oae?a eae e aicii?iinou iiaeeecaoee
Aianoa n oai ea?aiea IA cao?oaiaii ec–ca aua iaai- oea?eia, eeieaia e aaiiceoia oieanoa?eia a neiiaee e
noaoi?iiai a?naiaea eaea?noaaiiuo n?aanoa. O?aaeoeiiii noaoiia?aeuiuo e?iaaiinoiuo ninoaao, a oae?a oiaiu-
eniieucoaiua ianoa?ieaiua i?ioeaiainiaeeoaeuiua i?a- oaiey aiiioica oiia?ioeoia [13]. Aaiiue oaeo iineo-
?ee i?aaiinueeie aey nicaaiey eiiaeie?iaaiiuo
ia?aou (IIAI) ieacuaa?o neiioiiaoe?aneia aaenoaea,
i?aia?aoia n oaeu? iioaioe?iaaiey acaeiiaiiieiy?-
oiaiuoay aieaaie neia?ii e i?iyaeaiey ainiaeaiey a no-
noaaao. Iniiaiui iaainoaoeii aaiiuo i?aia?aoia yaeyao- uaai aaenoaey ON e A, a oae?a ?aaeecaoee anaai niaeo-
ny iaee?ea au?a?aiiuo iiai?iuo ?aaeoee, iniaaiii a io- ?a iaoaieciia eo aaenoaey. E?iia oiai, iaeioi?ua en-
iioaiee ?aeoai?ii–eeoa?iiai o?aeoa e na?aa?ii–nino- neaaiaaoaee iieaaa?o, ?oi yooaeo iaieo i?aia?aoia
aenoie nenoaiu; aieaa oiai, iaeioi?ua ec ieo io?eoaoaeu- iia auou i?aoaaee?ai ec–ca iaoiaieiae?aneeo ioeaie,
ii aeey?o ia iaoaaieeci nonoaaiiai o?yua. I?eiaiaiea o.e. a ?yaa ieaoaai–eiio?iee?oaiuo enneaaiaaiee ii-
i?aia?aoia, iioaioeaeuii niiniaiuo iiaeoeoe?iaaou ia- neaaieo eao ia auyaeaii ?acieou ia?ao i?aia?aoii e
iaiiua i?ioannu a o?yua, i?eaeaeaao e naaa aieiaiea ieaoaai ii aeeyie? ia aieu, neiaaiiinou e ooieoei-
i?a?aa anaai ec–ca eo aaciianiinoe i?e ea?aiee IA. Iie iaeuio? iaainoaoi?iinou nonoaaia [14].
oa?aeoa?eco?ony, n iaiie noi?iiu, niiinoaaeiui n IIAI N?aaieoaeuii iaaaaii noaee iiyaeyouny ?aaiou ii
aaenoaeai ia aieu e ooieoe? nonoaaia, n a?oaie – iaeioi- ni?aoaiiiio i?eiaiaie? ON e A o aieuiuo n IA. I?aaii-
?uie oiia?ii?ioaeoeaiuie naienoaaie e niiniaiinou? eaaa?o, ?oi eo eiiaeiaoey ii?ao ieacuaaou aieaa auno-
iiaeeyou ia oa?aiea caaieaaaiey e aai enoia. ?ue e au?a?aiiue yooaeo ii n?aaiaie? n iiiioa?aieae,
Ia naaiaiyoiee aaiu iaeaieaa eco?aiiuie i?aia- ?oi iiaoaa??aaii yenia?eiaioaeuiuie enneaaiaaieyie
?aoaie, iaeaaa?ueie eae neiioii–iiaeoeoe?o?ue- [15]. Ioee?eoaeuiie iniaaiiinou? oaeeo eiiaeie?iaai-
ie, oae e no?oeoo?ii–iiaeoeoe?o?ueie naienoaaie, iuo i?aia?aoia yaeyaony a?aiy ianooieaiey yooaeoa a
yaey?ony oiia?ieoei noeuoao (ON) e ae?eicaiei (A). n?aaiai ?a?ac 2–8 iaaaeu io ia?aea ea?aiey e nio?aiaiea
Eo yooaeoeaiinou a ea?aiee IA o?a aieacaia ?yaii aai a oa?aiea 2–3 ianyoaa iinea caaa?oaiey oa?aiee.
yenia?eiaioaeuiuo e eeeie?aneeo enneaaiaaiee, a ei- Yooaeoeaiinou eiiaeie?iaaiiie oa?aiee i?iaa-
oi?uo i?iaiaeeanu ioaiea eae neiioiiaoe?aneiai yo- iiino?e?iaaia a ?yaa ioe?uouo enneaaiaaiee (ioaie-
aaeenu i?aia?aou Oiia?i iiaa e A?o?a). I?aia?ao Oa-
oaeoa yoeo i?aia?aoia, oae e ?aioaaiieiae?aneie i?i-
?aoeaen oi?a i?aanoaaeyao niaie eiiaeiaoe? 2–o ni-
a?annee caaieaaaiey (aeiaieee no?aiey nonoaaiie ua-
ee) ia oiia eo i?eiaiaiey. eae – oiia?ieoei noeuoaoa (400 ia) e ae?eicaiei aea-
Yooaeoeaiinou ON e A o iaoeaioia n IA i?iaaiii- ?ioei?eaa (500 ia) a iaiie eainoea. Ioe?uoia enneaai-
no?e?iaaia a ianeieueeo iiiaioaio?iauo aaieiuo nea- aaiea aaiiiai i?aia?aoa o aieuiuo n IA auei i?iaaaa-
iuo ieaoaai–eiio?iee?oaiuo enneaaiaaieyo, a eioi?uo ii a AO Einoeooo ?aaiaoieiaee ?AII.
Oaeu enneaaiaaiey: eco?aiea eeeie?aneie yooae-
ioia?aii aicaaenoaea i?aia?aoia ia aieaaie neia?ii,
iicaiey?uaa oiaiuoeou iio?aaiinou a IIAI [1–3], a oeaiinoe, ia?aiineiinoe, aaciianiinoe e aeeoaeuiinoe
oae?a noaaeeece?o?uaa aeeyiea eo ia oe?eio nonoaaiie iineaaaenoaey i?aia?aoa Oa?aoeaen o iaoeaioia n aii–
uaee [4–6]. Iiieii yoiai, aaiiie a?oiia eaea?noaaiiuo e eiena?o?icii.
n?aanoa naienoaaiii iaee?ea iineaaaenoaey, o.a. nio?a-
Iaoa?eaeu e iaoiau
iaiey eeeie?aneiai yooaeoa a oa?aiea ii?aaaeaiiiai
a?aiaie iinea eo ioiaiu (ai 4–o iaaaeu aey A [7] e ai 3–o
Iaoeaiou: enneaaiaaiea i?iaaaaii o 50 aiaoeaoi?-
ianyoaa aey ON [2]), a oae?a oi?ioay ia?aiineiinou.
I?e eco?aiee iaoaieciia aaenoaey ON e A auei ia- iuo aieuiuo (48 ?aiuei e 2 io??ei) n IA eieaiiuo
ia?o?aii, ?oi iie ai iiiaii niaiaaa?o: iaa i?aia?aoa (88%) eee oaciaaa?aiiuo (12%) nonoaaia. Aeaaiic oaia-
niiniaiu iiauoaou neioac i?ioaiaeeeaiia e eieeaaaia, eaoai?ye aeaaiinoe?aneei e?eoa?eyi IA Aia?eeaineie

525

13, 8, 2005
eOCaAieaeEau
eieeaaee ?aaiaoieiaia. N?aaiee aic?ano aieuiuo, aee?- ianyoa io ia?aea oa?aiee. Iinea ioiaiu i?aia?aoa (a
?aiiuo a enneaaiaaiea, ninoaaee 61,3 aiaa (io 45 ai 70 oa?aiea 2–o ianyoaa) oeo?oaiea nio?aiyeinu ii anai
eao), aeeoaeuiinou caaieaaaiey – 8,2 aiaa (40% aieuiuo ninoaaey?uei eiaaena WOMAC, e oioy ioia?aeinu ia-
eiaee aaaiinou aieacie iaiuoa 5 eao, 38% – 5–10 eao e aieuoia ia?anoaiea eo cia?aiee, ie iaei ec iieacaoa-
22% – aieuoa 10 eao). Ana aieuiua eiaee II (82,2%) eee III eae ia aa?ioeny e enoiaiiio o?iai?, ?acee?ey nio?aiy-
(17,8%) ?aioaaiieiae?aneo? noaae? aii– eee eiena?o?ica ee noaoenoe?aneo? ainoiaa?iinou ii n?aaiaie? n enoia-
ii Kellgren–Lawrence, au?a?aiiue aieaaie neia?ii (ei- iuie aaiiuie. Aeiaieea eiaaena WOMAC ia oiia oa-
oaineaiinou aiee i?e oiauaa 40 ii e aieaa ii aecoaeu- ?aiee Oa?aoeaenii e a ia?eia iaae?aaiey i?aanoaa-
iie aiaeiaiaie oeaea – AAO), i?eieiaee IIAI ii eaia a oaaeeoa 1.
iaiuoae ia?a 30 aiae ca iineaaiea 3 ianyoa. E?eoa?ey- Oiaiuoaiea aieaaiai neia?iia, neiaaiiinoe e ooie-
ie enee??aiey yaeyeenu: eioaineaiinou aiee i?e oiauaa oeiiaeuiie iaainoaoi?iinoe ioiineoaeuii ia?aiia?aeu-
iaiaa 40 ii ii AAO, aoi?e?iue IA, iaiia?aiaiiia i?e- iuo aaee?ei ninoaaeei ?a?ac 4 ianyoa oa?aiee Oa?aoea-
iaiaiea a?oaeo oiia?ii?ioaeoi?ia. Ana iaoeaiou iiaie- enii 36,7%, 41,6% e 24,4% niioaaonoaaiii. Ia yoii oiia
naee niaeanea ia o?anoea a enneaaiaaiee. o 26 iaoeaioia oaaeinu nieceou aico eaoi?ioaia n 1200
Aecaei: aeeoaeuiinou enneaaiaaiey ninoaaeea 6 ia- ai 800 ia a aaiu, a o 3 iaoeaioia – ioiaieou i?aia?ao.
nyoaa. A oa?aiea 4–o ianyoaa aieuiua iieo?aee Oa?ao- Iauay yooaeoeaiinou 4–iany?iie oa?aiee Oa?aoea-
eaen (2 eainoeu a nooee ia?aua 3 iaaaee, aaeaa ii 1 eai- enii a aieuoeinoaa neo?aaa auea ioaiaia eae oeo?oaiea,
noea a nooee) e eaoi?ioai (ii 400 ia 3 ?aca a nooee n aic- a oa?aiea 2–o ianyoaa iaae?aaiey aac oa?aiee o 14,8%
ii?iinou? iineaao?uaai nie?aiey aicu), e 2 ianyoa – aieuiuo ioia?aeinu oooaoaiea ninoiyiey (oaae. 2).
iaae?aaeenu aac ea?aiey. 11 aieuiui n 3–ai ianyoa ea?a- I?e aiaeeca ?acoeuoaoia oa?aiee o iaoeaioia, i?eie-
iey aica Oa?aoeaena auea iiauoaia ai 2 eainoe a nooee. ia?ueo 1 (n=36) e 2 (n=11) eainoeu Oa?aoeaena a nooee,
Ioaiea yooaeoeaiinoe e ia?aiineiinoe i?iaiae- ainoiaa?iuo ?acee?ee a noaiaie oiaiuoaiey aieaaiai
eanu ii niaoeaeuii ?ac?aaioaiiie oaiaoe?aneie ea?oa. neia?iia, neiaaiiinoe e ooieoeiiaeuiie iaainoaoi?ii-
Eeeie?aneia ianeaaiaaiea aieuiuo inouanoaeyeinu a noe ioia?aii ia auei. Iaiaei aiaeec au?a?aiiinoe iin-
ia?aea enneaaiaaiey, ia 60, 120–e aie ea?aiey e 180–e eaaaenoaey i?aia?aoa auyaee nouanoaaiiua ?acee?ey
aaiu (ioaiea iineaaaenoaey i?aia?aoa iinea aai ioiaiu). ia?ao yoeie a?oiiaie. N?aae 36 aieuiuo, i?eieia?ueo
Yooaeoeaiinou Oa?aoeaena ioaieaaeanu ii iauai?eiy- 1 eainoeo Oa?aoeaena ia i?ioy?aiee anaai ia?eiaa ea?a-
oui e?eoa?eyi ioaiee i?aia?aoia aey ea?aiey IA: eiaa- iey, oeo?oaiea ninoiyiey a oa?aiea 2 ianyoaa iaae?aa-
eno WOMAC (ioaiea ii AAO aieaaiai neia?iia, oo?ai- iey ioiaoeee oieuei 44,4% aieuiuo. O 55,5% aieuiuo io-
iae neiaaiiinoe e ooieoeiiaeuiie iaainoaoi?iinoe), ii- ia?aeinu ionoonoaea yooaeoa, ec ieo o 11,1% i?iecioei
o?aaiinoe a IIAI, ioaiea yooaeoeaiinoe ea?aiey a?a- oooaoaiea – oneeaiea aieae a nonoaaao. O 11 aieuiuo, o
?ii e aieuiui. Noaoenoe?aneee aiaeec i?iaaaai n en- eioi?uo aica i?aia?aoa auea iiauoaia ai 2–o eainoe a
iieuciaaieai iauai?eiyouo noaoenoe?aneeo iaoiaee. nooee, yooaeo oa?aiee a ia?eia iaae?aaiey nio?aiyeny.
Ia?aiineiinou Oa?aoeaena auea oi?ioae, iaae?-
?acoeuoaou aaaiua ia?aeaoaeuiua yaeaiey a iniiaiii auee nay-
caiu n ni?aoaiiui i?eaiii eaoi?ioaia.
Ia?aeaoaeuiua yaeaiey i?eaaaaiu a oaaeeoa 3.
Iieiue 6–iany?iue eo?n ea?aiey caaa?oeee 47 ia-
oeaioia. O aaoo aieuiuo, auauaoeo ec enneaaiaaiey, Oaaeeoa 2. Iauay yooaeoeaiinou oa?aiee
auee aeaaiinoe?iaaiu iiooieaaua i?ioannu: o 1 ?ai- Oa?aoeaenii
ueiu (63 eao) a iiei?iie ?aeaca e o 1 io??eiu (75 eao)

a eaaeeo (aieuiua iieo?aee Oa?aoeaen a oa?aiea 1,5 2 . 4 . 6 . 2 . 4 . 6 .
ianyoaa, ?acaeoea iiooieaauo i?ioannia, ii iiaie? Cia?eoaeuiia
– – – 6,7% 7% –
enneaaiaaoaeae, ia naycaii n eco?aaiui i?aia?aoii). oeo?oaiea
Oeo?oaiea 86,6% 83,7% 44,4% 77,8% 74,4% 37%
O?aouy aieuiay auauea ec–ca ?acaeoey aano?aeaee e ia-
Ionoonoaea
oai?ecia ia oiia i?eaia Oa?aoeaena. 13,3% 13,9% 40,7% 13,3% 11,6% 44,4%
yooaeoa
Aiaeec ?acoeuoaoia iieacae ainoiaa?iia nie?aiea
Oooaoaiea – 2,3% 14,8% – 4,6% 14,8%
ooieoeiiaeuiiai eiaaena WOMAC o aieuiuo ?a?ac 4
Cao?oaiy?nu
– – – 2,2% 2,3% 3,7%
ioaaoeou
Oaaeeoa 1. Aeiaieea eiaaena WOMAC
ia oiia oa?aiee Oa?aoeaenii e a ia?eia
Oaaeeoa 3. Ia?aiineiinou Oa?aoeaena
iaae?aaiey

N

2 4 6
Naycaia n ni?aoaiiui i?eaiii
Aieu a nonoaaao1 352,87 249,9* 223,44* 243,88*
E?aieaieoa 1 aioeaiaeia, eoie?iaaia
Neiaaiiinou 54,46 40,63 31,81* 35,1*
iinea ioiaiu i?aia?aoa
Ooieoeiiaeuiay
879,48 705,06* 664,74* 713,70* Ia?ooaiea Ii?iaeecaoey c?aiey iinea
iaainoaoi?iinou1 1
oaaoiiai c?aiey ioiaiu eaoi?ioaia
Noiia?iue
1286,81 995,59* 919,99* 992,68* En?aciiaaiea aieae iinea ioiaiu
eiaaen WOMAC Aano?aeaee 2
eaoi?ioaia
1
– i?aanoaaeaiiua cia?aiey yaey?ony n?aaieie noiia?iuie aaee?e?
Aano?aeaee,
iaie ia?aiao?ia ioaiee aiee e ooieoeiiaeuiie iaainoaoi?iinoe 1 Ioiaia Oa?aoeaena e eaoi?ioaia
caii?u


526 13, 8, 2005
Caee??aiea
Oaeei ia?acii, Oa?aoeaen yaeyaony yooaeoeaiui i?aia?aoii aey ea?aiey IA e?oiiuo nonoaaia. A ia-
noiyuai enneaaiaaiee iiaoaa??aaii aai neiioii–iiaeoeoe?o?uaa aaenoaea: i?aia?ao yooaeoeaii oiaiuoaao
aieu, nio?aiyao e oeo?oaao ooieoe? nonoaaia, iicaieyao nieceou aico i?eiaiyaiuo IIAI. E?iia oiai, Oa?aoeaen
iaeaaaao oi?ioae ia?aiineiinou? e aaciianiinou?. Aianoa n oai aey iieo?aiey noieeiai e au?a?aiiiai yooae-
oa iaiaoiaeii, ii–aeaeiiio, i?iaiaeou oa?aie? a iinoiyiiie aica 2 eainoeu a nooee.
Aey iiaoaa??aaiey no?oeoo?ii–iiaeoeoe?o?ueo naienoa eiiaeie?iaaiiie oa?aiee iaiaoiaeii i?iaaaaiea
aaeuiaeoeo aeeoaeuiuo enneaaiaaiee n ioaieie «eiia?iuo oi?ae» caiaaeaiey i?ia?anne?iaaiey, o.a. eciaiaiey
oe?eiu nonoaaiie uaee ia ?aioaaiia?aiiao e iauaia nonoaaiiai o?yua ia I?O, a oae?a ii?aaaeaieai eiioaio-
?aoee iao?eeniuo aaeeia a nuai?ioea e?iae e neiiaeaeuiie ?eaeinoe.

aEUA?UU?
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Osteoarthritis Cartilage, 1999;7, Suppl A, abstr 144.
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7. Rovati LC. Clinical efficacy of glucosamine sulfate in osteoarthritis of the spine. Rev Esp Reumatol 1993;20:325.
8. Baici A, Bradamante P. Interaction between human leukocyte elastase and chondroitin sulfate. Chem Biol Interaction 1984; 51:1–11.
9. Lippielo L, Grande D. In vitro chondroprotection of glucosamine and chondroitin sulfate in a rabbit model of a OA and demonstration of metabolic synergy on chondrocyte in vitro.
Ann Rheum Dis 2000, 59 (Suppl 1):266.
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