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Treatment of osteoarthritis: systemic enzyme therapy
Last reviewed: 22.11.2021
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Systemic enzyme therapy was developed in 1954 by M. Wolff and K. Ransberger and is successfully used in Europe and the US in the treatment of various diseases accompanied by an inflammatory syndrome.
It is a question of gastro-resistant tableted forms of such enzymes as papain, bromelain (vegetable proteins), trypsin and chymotrypsin derived from the pancreas of animals.
The use of modern diagnostic methods allowed to objectify the effectiveness of systemic enzyme therapy and to approach the solution of the problem of resorption of enzymes from the lumen of the small intestine into the blood.
After entering into the blood, mainly in lymph, in the proteinase associated with a 2 -macroglobulin form penetrate the liver and lungs, where the effect on the macrophages and the functional cells of these organs, by changing their metabolism that manifests antitoxic liver function improvement or enhancement of barrier function of the lung .
Exogenous proteinases, interacting in the blood with a 2- macroglobulin, can affect the metabolism of biologically active substances released in the inflammatory focus (bradykinins, leukokinins). Proteolytic enzymes are able to cleave these peptides, providing anti-edematous and anti-inflammatory effects, especially in chronic inflammatory diseases that occur with a violation of microcirculation. Improvement of microcirculation is due to the fibrinogenolytic effect of the preparations of systemic enzyme therapy, as well as the ability to increase the activity of the tissue activator of plasminogen, which is inhibited due to the presence of a chronic inflammatory process.
Modulation of the activity of cytokines, growth factors (TGF-beta) with the help of systemic enzyme therapy is of particular interest in connection with the imbalance observed in osteoarthrosis in the immune system. It is known that the excess of IL-1 and TNF plays a big role in the pathogenesis of synovitis and damage to cartilaginous tissue in osteoarthritis, therefore the ability of activated proteinazoic a- 2- macroglobulin to excrete and inactivate them is very important .
Given these properties of the preparations of systemic enzyme therapy and the features of pathogenesis a, F. Singer first applied Wobenzym in 1990 as an alternative to treatment with diclofenac. In a randomized double-blind study of the efficacy of Wobenzym in the treatment of osteoarthritis, the drug was prescribed on 7 tablets 3 times a day for 5 weeks. The clinical efficacy of systemic enzyme therapy was comparable to the results of diclofenac treatment at a dose of 100 mg per day during the same period.
Currently, in the treatment of patients with osteoarthritis is widely used the preparation of systemic enzyme therapy Phlogenzym. Trypsin and bromelain, which are part of this drug, inactivate adhesion molecules, including PSAM-1, IKAM-2 and LFA-3, which play an important role in inducing inflammation. This action of the drug also helps to reduce the intensity of the inflammatory reaction and thus regulates its course.
Systemic enzyme therapy in Ukraine was first used by V.N. Kovalenko in 1995 in the treatment of patients with rheumatoid arthritis and osteoarthritis. Later, it was successfully used in the treatment regimens of other rheumatic diseases in various clinics and centers of Ukraine.
Clinical experience in the treatment of patients with osteoarthritis with the use of preparations of systemic enzyme therapy Flogenzyme and Wobenzym in combination with NSAIDs and chondroprotectors. Kovalenko, LB Sholokhovoy (2001), O.V. Pishak (2002) proved the effectiveness, safety and good long-term results of combined pharmacotherapy. Flogenzyme was prescribed 2 tablets 3 times a day during the course of treatment (3-4 weeks).
Systemic enzyme course increases the functional activity of phagocytic blood cells that is accompanied by a decrease in IgA content, and CEC and 2 -macroglobulin in serum. The use of systemic enzyme therapy in patients with osteoarthritis with osteopenic changes prevents loss of BMD. After the second course of treatment, there is a significant decrease in plasma proteolytic activity, blood content of peroxidized proteins, medium-weight molecules in normalizing the level of ceruloplasmin and metabolism of carbohydrate-protein components of connective tissue.
Currently, systemic enzyme therapy is included in the standards recommended by the Association of Rheumatologists of Ukraine for the treatment of rheumatic diseases.