Evaluation of the clinical course of gonarthrosis in patients with metabolic syndrome during complex treatment using osteopathic correction of somatic dysfunctions

Title. Assessment of the impact of osteopathic correction of somatic dysfunctions on pain intensity, functional status, and average daily paracetamol requirement in patients with gonarthrosis (GA) and metabolic syndrome (MS). Methods. A single-center, randomized, prospective study evaluating the clinical course of GA in patients with MS (n=49) was conducted. Patients were blindly allocated into two groups: the main group (n=20) received pharmacotherapy (chondroitin sulfate 1000 mg/day, glucosamine hydrochloride 1000 mg/day, paracetamol 500–1000 mg/day as needed) plus a course of osteopathic correction (4 sessions); the control group (n=29) received pharmacotherapy alone according to the same regimen. Treatment outcomes were assessed at baseline and on day 30 using the VAS, WOMAC index, daily paracetamol dose, and severity of somatic dysfunctions (main group only). Statistical analysis was performed using nonparametric tests: the Wilcoxon signedrank test for withingroup comparisons and the Mann–Whitney U test for betweengroup comparisons. Data are presented as median (25th, 75th percentiles) and the χ² test for categorical variables. Differences were considered statistically significant at p<0.05. Results. Both groups showed a significant reduction in VAS pain scores and WOMAC index (p<0.01) with no intergroup differences. In the main group, paracetamol requirement decreased from 1000 to 500 mg/day (p<0.01), whereas it remained unchanged in the control group. The severity of somatic dysfunctions in the main group decreased from 2.1 to 1.5 points (p<0.01). Conclusion. The use of osteopathic correction techniques for somatic dysfunctions in the complex treatment of patients with GA contributes to a twofold reduction in the need for paracetamol while maintaining a comparable analgesic effect in the short-term observation period and,   therefore, reduces the potential risks of its adverse effects that develop when it is used in patients with MS.

1. Mazurov V. I., Gaydukova I. Z., Belyaeva I. B. Clinical Rheumatology: A Guide for Physicians / edited by V. I. Mazurov. 3rd ed., revised and expanded. Moscow: E-noto, 2021. 696 p. (In Russ.).

2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392 (10159): 1789–1858.

3. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019; 393 (10182): 1745–1759.

4. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012; 8 (12): 729–737.

5. Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links? Diabetes Res Clin Pract. 2019; 156: 107848.

6. Yusuf E, et al. Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis. 2010; 69 (4): 761–765.

7. Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease? Joint Bone Spine. 2013; 80 (6): 568–573.

8. Courties A, Sellam J, Berenbaum F. Metabolic syndrome-associated osteoarthritis. Curr Opin Rheumatol. 2017; 29 (2): 214–222.

9. Bruyère O, Honvo G, Veronese N. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019; 49 (3): 337–350.

10. Bannuru RR, Osani MC, Vaysbrot EE. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019; 27 (11): 1578–1589.

11. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020; 180: 114147.

12. Roberts E. et al. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016; 75 (3): 552–559.

13. Chandrasekaran A. et al. The association of paracetamol use with all-cause and cause-specific mortality in patients with osteoarthritis: a population-based cohort study. Rheumatology (Oxford). 2023; 62 (1): 267–275.

14. Mokhov D. E., Tregubova E. S., Potekhina Yu. P. Osteopathy and Its Restorative Potential. St. Petersburg: Nevsky Rakurs; 2020. 200 p. (In Russ.).

15. Belyaev A. F. Somatic Dysfunction. Clinical Guidelines 2023. Russian Osteopathic Journal. 2023; 2 (61): 8–90. (In Russ.).

16. Licciardone JC. et al. Osteopathic manual treatment in patients with chronic low back pain: a randomized controlled trial. Spine J. 2020; 20 (8): 1195–1206.

17. Lunghi C. et al. Osteopathic manipulative treatment and the management of somatic dysfunctions in patients with knee osteoarthritis: a retrospective study. J Bodyw Mov Ther. 2020; 24: 148–155.

18. Altman R., Asch E., Bloch D. et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee / Arthritis and Rheumatism.1991; 34 (5): 505–514.

19. Alberti K. G., Zimmet P., Shaw J. et al. The metabolic syndrome – a new worldwide definition / The Lancet. 2005; 366 (9491): 1059–1062.

20. Licciardone JC. et al. Osteopathic manual treatment for knee osteoarthritis: a randomized controlled trial. J Am Osteopath Assoc. 2018; 118 (8): e1–e12.

21. Pozzi F. et al. Manual therapy for knee osteoarthritis: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2020; 50 (11): 612–625. DOI: 10.14412/1996-7012-2021-6-117-123

22. Mazurov V. I., Belyaeva I. B., Trofimov E. A., Itskovich I. E., Burulev A. L. Comparative efficacy of a combination of undenatured type II collagen, Boswellic acids, methylsulfonylmethane, vitamins C and D 3 and a combination of chondroitin sulfate and glucosamine hydrochloride in the treatment of primary osteoarthritis of the knee joint. Terapevticheskii Arkhiv. 2023; 95 (12): 1141–1150. DOI: 10.26442/00403660.2023.12.202540