3+ 4/2002 - Společnost pro pojivové tkáně

favour of DCF, which decreased to 29.74 %
of the baseline value, while main value of
PCH group decreased after one month
treatment to 65,2 % only (Fig. 1). After two
months treatment (visit 3) differences in
Lequesne Index under all three groups
were minimal (Fig. 1). At visit 5 (8 weeks
after therapy withdraw) the scores
increased in the DFC group, while a further
continuous decrease was observed in the
PHC group as well as in the group of combined
therapy (DCH+PCH). In both the
PCH groups LI scores improved definitely
during the trial, until the follow-up examination
the scores mostly increased again for
the DCF monotreatment group (visit 5) it
even reached values close to those
obtained prestudy (16.31 versus 15.31).
Laboratory markers showed a fairly
large spread of results under patients and
therefore there were no clearly recognizable
trends for changes (Tab. 4). Nevertheless
in some patients the outcome values
decrease of was substantial: UPD outcome
values decreased during 12 weeks PCH or
PCH+DCF treatment in 6 patients. When
patients were treated with DCF only in two
of them the decrease was greater – from
139.0 nmol/creat mmol to 28.2 and from
68.4 to 19.0 (Fig. 2). There was a marginal
tendency for an increase in BAP during the
treatment periods. Only in some patients
slight upregulation of BAP values was
observed (Fig. 3). At the treatment withdraw
(visit 4), the chondrex average values
showed a definite improvement for both
PCH groups but not for DCF (Fig. 4).
According to the doctor's evaluation
the poorest effect was observed at week 12
with PCH (Tab. 5). On the other hand
patients evaluated the combined treatment
(PCD+DCF) as the best (Tab. 6).
64
DISCUSSION
LOCOMOTOR SYSTEM vol. 9, 2002, No. 3+4
Big advantage of PCH treatment is its
very good tolerability in contrast to DCF or
other NSAID, especially at the gastrointestinal
level. According to our experience on
many patients with postmenopausal osteoporosis
treated with PCH this substance is
not causing any gastrointestinal troubles
(Adam et al., 199X, Adam et al., submitted
for publication). This is certainly an advantage
of PCH to NSAID, which are causing
peptic ulcers as potent inhibitors of proteosynthesis.
The risk factors for progression
are different from those for OA initiation
as shown recently by Copper et al.,
1997) and most mild OA does not progress
to severe joint damage. It cannot be excluded
that some immune processes play an
important role especially in the etiopathogenesis
of coxarthrosis, as there is a subgroup
of OA patients with high serum levels
of collagen type I, II, III antibodies
resembling those in rheumatoid patients
(Novotná and Adam, 1986). As mentioned
earlier factors involved in the progression
of OA are proinflammatory cytokines,
among these a pivotal role play IL-1a and
TNF á (Van de Loo et al., 1995), which are
sythesized as inactive precursors and must
be therefore activated before being
released extra cell compartment. The inhibition
of Il-1a and TNF á may be an attractive
therapeutic target. The published
results of UPD as well as of chondrex show
that PCH is effective in decreasing some
proteolytic activities
The effect of chondroitin sulfate published
by Morreale et al. (1996) was similar
to that presented in this paper with PCH.
Both the substances diminished patients
troubles connected with OA. The effect of
PCH like to that of chondroitin sulfate sim-