风湿

口服胶原对对关节痛—OA和RA的疗效研究

作者:佚名 来源:中华风湿 日期:2017-07-19
导读

          口服胶原对关节痛—骨关节炎 和类风湿性关节炎的疗效研究

关键字:  口服胶原 

背 景

        关节痛是最常见的一种慢性病。骨关节炎(OA)和类风湿性关节炎(RA)是关节痛的两大主要病因,目前尚无有效的预防或治愈手段,而口服胶原已被证明是治疗关节炎的潜在手段。

目 的

        本文旨在确认、评估并总结已发表的关于口服胶原治疗OA和RA引发关节痛的动物和人体实验。

方法论

        作者利用EMBASE和医学数据库搜索文献,搜索关键词包括“骨关节炎”、“类风湿性关节炎”、“关节痛”和“口服胶原”,同时搜索包含以下内容的文章:随机控制实验、临床实证以及包含初级定量数据的动物模型,与关节痛、关节疾病、OA或RA相关的口服胶原体外实验。

方 法

        用EMBASE数据库搜索1947年至今的文章,医学数据库搜索1946年至今的文章,搜索关键字或标题包括“骨关节炎”、“类风湿性关节炎”、“关节痛”和“口服胶原”,搜索包含以下内容的文章:随机控制实验、临床实证以及包含初级定量数据的动物模型,与关节痛、关节疾病,OA或RA相关的口服胶原体外实验,排除非口服胶原研究、非关节疾病或与OA或RA无关的研究。只有动物或人的临床研究会被用来进行分析。为了测定疗效,研究通过WOMAC(西安大略麦克马斯特大学骨关节炎指数)确定口服胶原对OA的疗效,口服胶原对RA的疗效主要通过测定ACR(美国风湿学会)标准完成。WOMAC和ACR已得到广泛应用,分别用来监测病人的OA或RA病情变化。

结 果

        众多临床前和临床研究针对口服胶原对OA和RA的影响。口服胶原多以非变性或部分变性形式作用于OA患者,总体而言较为有效,但仍需进一步实验以证实疗效。相较而言,口服胶原对RA患者的疗效饱受争议,特别是和现行疗法甲氨蝶呤相较而言。

结 论

        为OA和RA患者研发出更有效的疗法困难重重。现今的疗法只能做到缓解病症,起不到治疗效果。近期对于口服胶原补品的关注引导更多的临床前和临床研究探索其疗效。临床前研究已经证实非变性口服胶原主要作用于口服耐受机制,部分变性胶原可能会刺激细胞外基质成分生成。总体而言,口服胶原以非变性或部分变性形式对OA颇为有效,但仍需大规模、更长期的实验以验证药效。然而口服胶原对抗RA的疗效仍然存疑,诚然它的疗效优于安慰剂,但仍不及现行疗法甲氨蝶呤。然而,口服胶原以良好的患者耐受性和安全性著称,在未来或许不失为一种更有吸引力的疗法。

原 文

Efficacy of Oral Collagen in Joint Pain - Osteoarthritis and Rheumatoid Arthritis

        Woo T11, Lau L1, Cheung N1, Chan P1, Tan K2 and Gardner A2*

        1Cardiff University, School of medicine, UK

        2Welshbone, South Wales Orthopaedics Research Network, Wales, UK

        *Corresponding Author:Andrew GardnerWelshbone, South Wales Orthopaedics ResearchNetworkWales, UKTel: +61 4321 555 18E-mail: andrewgardner25@gmail.com

        Received date: February 11, 2017; Accepted date: February 26, 2017; Published date: February 28, 2017

        Citation: Woo T, Lau L, Cheung N, Chan P, Tan K, et al. (2017) Efficacy of Oral Collagen inJoint Pain-Osteoarthritis and Rheumatoid Arthritis. J Arthritis 6: 233. doi:10.4172/2167-7921.1000233

Introduction

        Joint pain is one of the most common types of chronic pain. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two leading causes of joint pain and there are currently no prophylactic or curative treatments available. Oral collagen has been implicated in providing a potential means to treat arthritis.

Aim

        This review article aims to identify, evaluate and summarize the results of published animal and human clinical trials related to oral collagen in the treatment of joint pain caused by OA and RA. Methodology: Articles were searched using EMBASE and Medline databases. Search terms for keywords and titles included: “osteoarthritis”, “rheumatoid arthritis”, “joint pain”, “oral collagen”. Articles containing the following are included in our search: randomized controlled trials, clinical evidence and animal models containing primary quantitative data, in vitro studies of oral collagen related with joint pain, joint disease, OA or RA.

Method

        Articles were searched using EMBASE database from 1947 to present, and Medline from 1946 to present. Search terms for keywords and titles included: “osteoarthritis”, “rheumatoid arthritis”, “joint pain”, “oral collagen”. Articles containing the following are included in our search: randomized controlled trials, clinical evidence and animal models containing primary quantitative data, in-vitro studies of oral collagen related with joint pain, joint disease, OA or RA. Articles containing non-oral collagen studies, non-joint disease or those that were not related to OA or RA are excluded. Only the clinical studies involving animals or humans were selected for analysis and review. In order to determine efficacy, it was ensured that clinical assessment of the OA response to oral collagen was achieved via WOMAC (Western Ontario McMaster Osteoarthritis Index), whilst that of RA was done primarily through measuring the ACR criteria (American College of Rheumatology). Both WOMAC and ACR are widely employed as means of which to determine changes in the state of patients’ OA or RA respectively.

Results

        Numerous preclinical and clinical studies have been carried out to investigate the efficacy of oral collagen and both OA and RA. Oral collagen is administered either in an undenatured form or in a partially denatured form for patients with OA, and in general, has been found to be reasonably efficacious, although more trials will be required to confirm and consolidate these findings. In contrast, oral collagen has a more debatable response rate in patients with RA, especially when compared with methotrexate, an existing therapy.

Conclusion

        Developing more effective therapies for OA and RA represents a major challenge. At present, available treatments serve to ameliorate symptoms of the diseases, rather than act in a curative manner. Recent interest in oral collagen supplements has sparked preclinical and clinical studies into its efficacy. Preclinical studies have confirmed that the primary mechanism of action of undenatured oral collagen centres on a process of oral tolerance, whilst that of partially denatured collagen may potentially involve stimulation of production of extracellular matrix components. In general, oral collagen has been shown too efficacious against OA when administered as an undenatured or partially denatured form, although insufficient large scale, longer term trials have been conducted to consolidate current findings. Oral collagen’s efficacy against RA is to a certain extent still questionable, given that it has shown a better response in comparison to a placebo control, but perhaps not so when compared with methotrexate, an existing therapy for RA. However, oral collagen stands out in its superior tolerability and safety for patients, thus making it a potentially more attractive therapy in the future.

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