Introduction
Arthritis is a problem of the joints known to man from times immemorial
– about 60% of population with age group above 50 years suffer from joint pain. Also
1-2% of general population suffer from rheumatoid arthritis. Doctor’s armamentarium
revolves around NSAIDs which offer only temporary relief and does nothing to halt the
process of degeneration of the cartilage. Together Glucosamine and Chondroitin provide
joint care by promoting healthy cartilage in a healthy joint. Intecar offers a new hope
for arthritis sufferers with joint pain and inflammation.
Chondroprotective agents
Chondroprotective agents have been defined as a compound that can
accomplish the following six objectives in joint tissues (Ghosh, P.M. Smith, C. Wells.
Second-line agents in osteoarthritis, Chapter 15 in Second-Line Agents in the Treatment of
Rheumatic Diseases, J.S. Dixon, D.E. Furst, Eds., Marcel Dekker; New York, 1992, pp.
363-427).
Glucosamine
It is a natural constituent of cartilage found in the body and are
composed of a sugar and an amine moiety. It is utilized in the body to synthesize
glycosaminoglycans and glycoproteins. It stimulates faster re-growth of cartilage,
ligaments and other muscle motivators. These structures act as a sort of ‘pully’
when the muscle provides with the strength.
Basically glucosamine is a direct precursor and a stimulatory agent for
chondrocyte glycosaminoglycan synthesis. It is a chondroprotective agent having the
following qualities like –
A |
Enhances the chondrocyte
macro molecular synthesis (glycosaminoglycans, proteoglycans, collagen, protein DNA, RNA
etc.) |
B |
Enhances synthesis by
cartilage matrix |
C |
Reduces joint pains |
D |
Reduces synovitis. |
Chondroitin
Chondroitin is one of the predominant glycosaminoglycans. It is a
polymer of the repeating disaccharide unit of glucosamine sulphate and glucoronic acid.
The two active principles contained in chondroitin are also classified as a symptomatic
slow acting drug in relieving OA. The chondroprotective action of chondroitin has been
attributed to its vital role in increasing the proteoglycan synthesis causing decrease in
matrix destroying collagenase release from the articular cartilage and maintaining the
viscosity of synovial fluid. Chondroitin, like glucosamine, also increases RNA synthesis
by chondrocytes, which enhances the production of proteoglycans and collagen. Chondroitin
also prevents cartilage damage by blocking activity of elastase and hyaluronidase.
A double – blind controlled study showed chondroitin (400 mg.
b.i.d. for 6 months) to be well tolerated and efficacious in treating patients with knee
osteoarthritis.
VIT E
It is widely accepted as an antioxidant. It inhibits the oxidation of
membrane phospholipids thus helps to stabilize it.
The membrane stabilizing property as well as the fact that by
preventing the fatty acid peroxidation of the membrane lipids Vit E prevents the release
of inflammatory mediators.
This ensures further integrity of joint membranes and prevents it from
exposure to inflammatory mediators like IL-1, IL-6, TNF - a
etc.)
Simultaneously the membrane stabilizing effect also helps the
chondrocytes to retain the integrity and prevents the damage caused by lysosomal activity.
Vit C also aids in the functioning of Vit E as a reducing agent.
VITAMIN C
Ascorbate is a cofactor in hydroxylation of procollagen. Hence,
adequate availability of ascorbic acid will facilitate collagen synthesis by chondrocytes.
Since collagen contributes equally to the cartilage content, as proteoglycans, ascorbic
acid can play a major role in management of OA along with Glucosamine and Chondroitin. It
helps maintain integrity of substances of mesenchymal origin such as connective tissue and
osteoid tissue. Vitamin ‘C’ activates enzymes that hydroxylates procollagen
proline and lysine to hydroxyproline and hydroxylysine.
Manganese Sulphate
Manganese ions are essential as co-factors to carboxykinase enzymes
necessary for bone metabolism.
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