Which is better: DONA or ARTRA

Characteristics of drugs

To choose the right chondroprotector, you need to know what characteristics Arthra and Dona have.

Artra

This is a combined drug from the group of cartilage and bone tissue reparants, which is used to treat degenerative diseases of the spine and joints. Its active components are sodium chondroitin sulfate (500 mg) and glucosamine (500 mg). The dosage form of the drug is white tablets.

The active ingredients have the following effects:

• reduce the severity of degenerative changes and accelerate metabolic processes;
• stimulate regeneration and restoration of the cartilage surface;
• activate the production of synovial fluid, which improves joint mobility;
• reduce pain and relieve inflammation;
• normalize metabolism in cartilage tissues;
• accelerate the exchange of phosphorus and calcium;
• block free radicals and enzymes that destroy cartilage structure;
• prevent compression of connective tissue;
• restore the joint capsule;
• slow down the rate of development of osteoarthritis and alleviate its symptoms;
• inhibit bone destruction.

To restore the elasticity of cartilage tissue, doctors prescribe Artra or Dona.
Indications for use:

• rheumatic, post-traumatic, deforming osteoarthritis;
• pain syndrome arising due to degenerative changes in the joints and diseases of the musculoskeletal system;
• osteocondritis of the spine;
• chronic osteoarthritis;
• spondyloarthrosis;
• various local osteopathies;
• bone and joint infections;
• age-related deformation of the musculoskeletal system.

Contraindications include:

• hypersensitivity to the components of the drug;
• pregnancy;
• breast-feeding;
• severe diseases of the urinary system;
• children under 15 years of age.

The medication should be used with caution by people who suffer from bronchial asthma, diabetes mellitus, and those prone to various bleedings.

Adverse reactions include:

• insomnia;
• swelling of the lower extremities;
• headache;
• dizziness;
• constipation or diarrhea;
• increased gas formation, bloating and abdominal pain;
• tachycardia;
• allergic reactions - itching, redness, rashes.

We recommend reading: Muscle relaxant drugs for osteochondrosis: classification and list

Artra can cause insomnia.
If side effects develop, the dosage of the medication is reduced by 2 times. If there is no improvement, stop taking the drug.

Don

This is a drug that regulates metabolism in cartilage tissue. The main component is glucosamine sulfate, which is a natural substance present in the body and is responsible for metabolic processes in cartilage tissue. Dosage forms of the drug - capsules, powder, injection solution.

Dona is characterized by pronounced analgesic and anti-inflammatory properties. With regular use of the medication, the amount of glucosamine increases, joint fluid is replenished, and cartilage tissue is restored. Patients note that the affected joint begins to function normally and pain decreases.

Indications for use:

• osteoarthritis of various localizations (wrist, hip, knee arthrosis, osteochondrosis, spondyloarthrosis, etc.);
• chondromalacia patella;
• scapulohumeral periarteritis;
• arthrosis of the intervertebral space.

Contraindications:

• individual intolerance to components;
• pregnancy;
• breastfeeding period;
• children under 12 years of age;
• renal and liver failure;
• severe damage to the kidneys and liver.

If the dose recommended by the doctor is strictly followed, no negative reactions of the body will occur. If it is exceeded, the following side reactions are observed:

• nausea, pain in the stomach, increased gas formation in the intestines, abnormal stool;
• itching, redness of the skin, burning, rash;
• dizziness, numbness of fingertips, tremor of extremities, apathy, lethargy, drowsiness;
• heart rhythm disturbance, tachycardia.

Dona is used for chondromalacia of the patella.

Comparison of addiction in Dona and Arthra

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “syndrome” in Dona is quite similar to the similar values ​​in Arthra. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, in Dona the meaning of the “syndrome” is quite small, however, the same as in Arthra.

Comparison of Arthra and Dona

Before choosing a remedy, you need to find out what these drugs have in common and how they differ.

Similarities

These medications are used to treat joint diseases. They belong to chondroprotectors - substances that restore damaged joint cartilage, but are not analogues. Apart from the glucosamine included in the preparations (in different compounds), they have nothing else in common.

What is the difference?

The difference between the drugs is as follows:

• Arthra is produced by an American company, Dona by an Italian company;
• different dosage form;
• Artra has more indications and fewer contraindications;
• There is no chondroitin sulfate in the Don.

We recommend reading: Arthrocin - a natural drug that supports cartilage health

What is more effective?

Artra is considered a more effective drug, because it contains 2 active components. But Dona is beneficial when combined with another medication containing chondroitin, because it contains a larger amount of glucosamine.

Which is cheaper?

The price of Arthra is 1810 rubles, Dona is 1720 rubles.

Comparison of the effectiveness of Dona and Artra

The effectiveness of Dona is quite similar to Artra - this means that the ability of the medicinal substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Dona is more pronounced, then using Artra even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of therapeutic action - is approximately the same for Dona and Artra. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

Which is better - Arthra or Dona?

Only a doctor can determine which drug is best in each individual case.

For joints

Artra contains 2 components - chondroitin and glucosamine, which enhance each other's action and have a beneficial effect on the condition of cartilage and the production of synovial fluid, without which the joint cannot function normally. Therefore, doctors prescribe this drug most often.

For arthrosis

When choosing which drug is better for arthrosis - Artra or Dona, you need to rely on the doctor's opinion, because from the point of view of evidence-based medicine, such drugs, even when taken closely, may turn out to be ineffective. They show the greatest effectiveness in the early stages of the disease, and it is important to regularly massage the hip joints. In advanced cases, such medications are useless.

Comparison of safety of Dona and Arthra

The safety of a drug includes many factors.

At the same time, Dona’s is quite similar to Artra’s. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing Dona’s metabolism, as well as Arthra’s, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Dona does not have any risks when used, just like Arthra.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Dona and Arthra.

Patient reviews

Elena, 55 years old, Yaroslavl: “About 2 years ago I started having problems with my joints. After physical activity, pain in the legs began to appear, which quickly passed. Then the pain intensified and I began to limp. I used various ointments and gels, but their effect was so short-lived that I abandoned them. The doctor recommended the drug Artra, which I took for six months. After completing the course of treatment, the pain decreased and the joint stopped crunching. I tolerated the medication well. I’ll start another course of treatment soon.”

Dmitry, 60 years old, Tver: “I worked all my life in hazardous industries and often unloaded wagons at night. All this had a negative impact on the joints - cartilage tissue began to gradually deteriorate, and friction between the bones in the lower extremities began to increase. Severe pain appeared. The doctor prescribed Dona, which must be taken in three courses over a year. As a result, the pain has decreased and I can easily climb stairs. But such an unpleasant moment arose as intestinal upset.”

We recommend reading: Review of painkillers of Ibuprofen and their use

Numerous clinical studies of the use of chondroprotectors for osteoarthritis (OA) of the knee joint have shown their undoubted effectiveness in reducing the symptoms of this disease (reducing stiffness, restoring trophism of cartilage and joint tissue, improving the X-ray picture, reducing pain). However, recently, new data are increasingly appearing and clinical studies are being conducted evaluating the effect of chondroprotectors in diseases of the spine, chronic lumbodynia and intervertebral disc degeneration, the results of which are quite contradictory. In this article, we attempted to analyze how effective the administration of chondroprotectors is for back pain, whether they have their own antinociceptive effect, and how it is achieved, and whether these drugs can become a worthy alternative to nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics.

A Cochrane systematic review summarized the effectiveness of glucosamine from 25 randomized clinical trials [1]. According to these results, only when using original glucosamine sulfate preparations with a patented composition, an effect of relieving pain and improving joint function was observed, superior to the effect of placebo. Regarding the effectiveness of chondroitin, a review of 43 randomized controlled trials was recently published [2], including 4962 patients treated with chondroitin and 4148 patients treated with placebo. The duration of the studies ranged from 1 month to 3 years. This meta-analysis showed that during treatment with chondroitin (alone or in combination with glucosamine), there was a significant reduction in pain compared with the placebo group.

A review of 3 pooled studies of at least 2 years' duration reported a small but significant narrowing of joint space width [3]. According to the published results of a large randomized clinical trial, GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial), assessing the effectiveness of the combination of glucosamine hydrochloride and chondroitin sulfate in the treatment of symptomatic knee OA, there was no correlation with long-term improvement of symptoms or reduction of radiological morphological changes [4, 5]. However, the results of multivariate analysis suggested that patients with moderate to severe pain at baseline experienced a relative reduction in symptoms.

To globally evaluate the effectiveness of glucosamine and chondroitin in OA, a large-scale LEGS study was organized [6], which involved 605 people aged 45-75 years with chronic pain in the knee joints and signs of narrowing of the joint space in the medial tibiofemoral part of the knee joint ( while maintaining the width of the medial joint space >2 mm). Patients were randomized into 4 treatment groups (once daily or 1500 mg glucosamine sulfate ( n

=152), or 800 mg chondroitin sulfate (
n
=151), or a combination of these dietary supplements (
n
=151), or placebo capsules (
n
=151).
Patients self-rated and noted in diaries the maximum level of knee pain on a 10-point scale for 7 days every 2 months for more than 1 year. The treatment did not show a significant effect on the primary outcome of the disease in the treatment groups ( p
= 0.57), and there were no significant differences in the level of reduction in knee pain between any groups of patients, including placebo. The use of pain medications (or NSAIDs/opioids) remained stable throughout the follow-up period in all groups. Symptoms of knee pain and dysfunction (WOMAC scores) decreased from baseline to year 1, with no further improvement from year 1 to year 2 in all groups.

Most clinical studies describe both pronounced structural-modifying (restoration of trophicity of cartilage and joint tissues, improvement of the X-ray picture) and symptom-modifying effects (reduction of stiffness, pain) during therapy with chondroprotectors, and the latter often occurred earlier [7].

According to an open randomized study [8], in 58 patients with knee OA, radiological symptoms on the Kellgren-Lawrence scale (I-III) with the severity of pain and the degree of motor activity of 5 or less points for each of the signs on the Lequesne scale (with a total value Lequesne index 14) and pain intensity on a visual analogue scale (VAS) >5 points, taking combination therapy with glucosamine (1500 mg) and chondroitin sulfate (1200 mg) 2 times a day, there was a significant decrease in pain syndrome according to VAS, as well as improvement in indicators according to the WOMAC and Lequesne scales after 6 months of treatment, which became more pronounced after 1 year of therapy.

In the work of L. Tant et al. [9] compared the effects of traditional NSAID therapy and physiotherapeutic treatment for chronic lumbodynia with similar therapy with the addition of glucosamine. The study involved 36 patients with chronic back pain lasting more than 12 weeks, radiological signs of lumbar arthrosis and VAS pain intensity >3 points. Already by the end of the 4th week, there was a statistically significant reduction in pain at rest in the group treated with glucosamine compared to the control group, which persisted at the 8th and 12th weeks of treatment. At week 12 of therapy, significant differences were noted between groups in terms of pain during movement according to the VAS [10].

Of interest are the results of a prospective experimental pilot clinical study conducted by R. Klein et al. [11], in which a solution of chondroitin sulfate and glucosamine hydrochloride was injected directly into the intervertebral disc. We examined 36 patients aged from 27 to 62 years (average 46.5 years), suffering from long-term (about 8 years) chronic back pain that was not amenable to conservative and physiotherapeutic treatment. Intradiscal injections of 1-2 ml of a solution containing 0.5% chondroitin sulfate and 20% glucosamine hydrochloride were performed. In addition, injections of glucosamine hydrochloride were performed into the facet joints. As a result of therapy, 17 out of 30 patients showed a decrease in pain syndrome according to VAS by 76% compared to the initial level, and an improvement in quality of life and ability to work by 72%. In contrast, 13 patients had a minimal response to therapy, with an average reduction in VAS score of 14% and an improvement in quality of life of 8%.

In a double-blind, multicenter clinical trial, chondroprotectors demonstrated an antinociceptive effect comparable to that of selective cyclooxygenase-2 (COX-2) inhibitors [12]. The study included 606 patients over 40 years of age with radiographically confirmed knee OA and severe pain (> 301 WOMAC pain index on a scale of 0 to 500), randomized into 2 groups. In the first group, patients received chondroitin sulfate 400 mg and glucosamine hydrochloride 500 mg 3 times a day daily for 6 months; in the second - celecoxib 200 mg and placebo in the first dose, in the remaining two doses - 2 capsules of placebo. The results showed that combination therapy with glucosamine and chondroitin was comparable in effect to celecoxib, including in terms of pain. Within 6 months, there was a decrease in VAS pain by 48.0% in the chondroprotector group compared to 48.8% in the celecoxib group ( p

=0.92) (see figure). However, the effect of prescribing chondroprotectors was characterized by a gradual onset, smooth development, increase over time and stable results against the background of discontinuation of therapy, while the effect of celecoxib, although it occurred earlier and was somewhat more pronounced in the early stages of therapy, ceased to increase over time.

Dynamics of pain syndrome (VAS, mm) during therapy with glucosamine and chondroitin and celecoxib for 6 months.
The results of a pilot study conducted in Japan are quite eloquent regarding pain syndrome while taking chondroprotectors [13]. In it, one group of patients with chronic OA received chondroitin and glucosamine with the addition of antioxidants and microelements, and the other received a placebo. Already at the 4th week of treatment, a significant reduction in pain was observed in the main group, while no significant changes were noted in the placebo group. The dynamics of pain according to VAS are presented in table. 1.

Table 1. Changes in the three main characteristics of pain according to VAS (mm) during 16 weeks of therapy in the study group and the placebo group (n = 16 in each group) [13] Note. Values ​​are presented as mean ± standard deviation; * - p<0.05, ** - p<0.01 relative to the baseline (Student's t-test).

The effects of chondroprotectors have been actively studied in many Russian studies. Let's look at some of them using the example of the drug teraflex.

Theraflex is a combination of 2 salts - chondroitin sulfate (400 mg) and glucosamine hydrochloride (500 mg) in one capsule. There is another form of the drug for oral administration - teraflex advance, which contains chondroitin sulfate 200 mg, glucosamine sulfate 250 mg and ibuprofen 100 mg [14].

The feasibility of combining two main drugs with chondroprotective activity is explained by the possibility of potentiating the positive effect of each of them, which is associated with the peculiarities of the pharmacological action of glucosamine and chondroitin. They are synergists and, when used together, complement and enhance each other’s effects [15, 16]. According to the Department of Clinical Geriatrics and Organization of Gerontological Care of the Russian Medical Academy of Postgraduate Education, in women with an average age of 54.2 ± 7.6 years with postmenopause, the use of Teraflex for 6 months made it possible to significantly reduce the main manifestations of osteoarthritis (Table 2) while reducing the need in NSAIDs in 21% of patients or refusal to take NSAIDs in another 14% of patients.

Table 2. Dynamics of quantitative parameters of osteoarthritis while taking Teraflex Note. * — p<0.05; ** — p<0.01.

The possibility of using teraflex in a continuous and intermittent course was studied [17]: 50 patients received teraflex according to the usual regimen for 9 months, and 50 patients received teraflex for 3 months, then there was a 3-month break in treatment, then patients in this group received teraflex again . In general, by the end of the 9th month of the study, there were no significant differences between the effectiveness of the drug in both groups, although the severity of the effect was higher with constant use of the drug. In both groups, 34% of patients stopped taking NSAIDs.

The effect of Teraflex Advance was studied at the Institute of Rheumatology of the Russian Academy of Medical Sciences [18, 19] in comparable groups of 20 people with gonarthrosis, whose average age was about 58 years. Patients were randomized into 3 groups, 1 of which took Teraflex Advance at a dose of 6 capsules per day; patients of group 2 - teraflex 2 capsules per day and paracetamol in a daily dose of no more than 6 tablets (3 g); Group 3 - ibuprofen at a dose of 600-1200 mg per day (as needed). The researchers noted equal effectiveness of both forms of the drug - Teraflex and Teraflex Advance, clearly exceeding the effectiveness of ibuprofen in relation to pain, stiffness and functional impairment (WOMAC index). In another study [20], taking Teraflex Advance 2 capsules 2 times a day allowed achieving an analgesic effect after 2 weeks of use, and when taking the usual form of Teraflex (1 capsule 2 times a day) - after 2 months.

The results discussed above reliably confirm the presence of an antinociceptive effect in chondroprotectors, which is characterized by an early onset and gradual development with long-term preservation of the result even after discontinuation of therapy. Currently, the effectiveness of chondroprotectors has been studied and confirmed in many experimental and clinical studies [21–24]. They are an obligatory component of complex therapy for OA, recommended for this purpose by the European League Against Rheumatism (EULAR) [25] to reduce pain and improve joint function; the effect persists for several months after discontinuation of chondroprotectors; in addition, they are well tolerated by patients. The use of chondroprotectors slows down the progression of degenerative changes in the joints and spine and has a delayed anti-inflammatory and analgesic effect.

Along with degenerative changes, inflammation plays a very important role in the development and progression of OA. In the affected joint, the production of “pro-inflammatory” cytokines, cyclooxygenase, increases, which initiates inflammatory reactions and aggravates damage to cartilage tissue and surrounding structures of the joint. Interleukin-1β (IL-1β), which is expressed in OA-affected cartilage and stimulates the production of metalloproteinases, plays a key role in the cascade of proinflammatory mediators [26, 27]. In addition, IL-1β inhibits the expression of collagen and proteoglycans, stimulates the synthesis and release of eicosanoids - prostaglandins and leukotrienes. Increased production of nitric oxide triggers chondrocyte apoptosis [28].

The antinociceptive effect of chondroprotectors is probably associated with a direct effect on proinflammatory cytokines, markers of systemic inflammation.

Some in
vivo
and
in vitro
have shown that chondroprotectors have anti-inflammatory properties and are able to reduce the level of pro-inflammatory cytokines in the blood. One of the targets of glucosamine in chondrocytes has been shown to block the effects of interleukin-1β, thereby inhibiting inflammatory enzymes such as nitric oxide synthase and cyclooxygenase-2 [29]. Experiments on rats demonstrated the ability of glucosamine to alter nociception, in particular to reduce the degree of mechanical allodynia. In addition, when taking glucosamine, the formation of pro-inflammatory cytokines IL-6 is inhibited and the production of anti-inflammatory cytokines IL-10 is activated in the synovial membrane [30].

These interactions have also been studied in the human body - according to the VITAL (VITamins and Lifestyle) association study, in 217 men and women who took part in the experiment, there was a clear correlation between the use of chondroprotectors and the level of markers of systemic inflammation. Patients using high doses of chondroitin (14 or more tablets per week) had a 36% decrease in high-sensitivity C-reactive protein in the blood and a 27% decrease in PGE-M (prostaglandin E, a metabolite in the urine) compared to baseline [31]. .

Unfortunately, the number of similar studies evaluating the relationship of glucosamine and chondroitin supplementation with other biomarkers of inflammation in the human body is very limited. Understanding the patterns and associations between the use of these drugs and inflammatory biomarkers may shed light on the biological mechanisms involved. It is important to understand the potential anti-inflammatory effects of chondroprotectors, since reducing systemic inflammation may provide impetus for new strategies for the prevention and treatment of diseases that cause it, such as cancer and cardiovascular diseases. For example, long-term use of glucosamine and chondroitin has been found to reduce the risk of developing colorectal cancer [32] and lung cancer [33].

Traditionally, chondroprotectors were considered exclusively as substances that act only on the trophism of cartilage and its structure, and their effects were often associated with a direct effect on cartilage tissue and its partial restoration. However, numerous clinical studies have demonstrated that the symptom-modifying effect (reduction of pain) occurs much earlier than the structure of the cartilage tissue is restored.

The results of a number of randomized placebo-controlled studies demonstrate a pronounced antinociceptive effect of chondroprotectors, comparable to that of NSAIDs, not only in the treatment of OA, but also in chronic back pain, which opens up new opportunities for clinicians in the treatment of this condition. It should be remembered that side effects with long-term use of NSAIDs are much more frequent and dangerous than those of chondroprotectors [34, 35].

Today, ideas about the mechanisms of action of chondroprotectors have changed significantly. This is primarily due to the discovery of their independent anti-inflammatory and analgesic properties. The data obtained in numerous studies confirming the ability of these drugs to inhibit proinflammatory cytokines opens up new prospects for their use in the treatment of not only arthralgia, but also other chronic pain syndromes. Of course, new research is needed to clarify important issues for clinicians regarding dosages, timing and predictors of treatment, and to assess possible undesirable effects for different types of pain syndromes.

Reviews from doctors about Artre and Don

Alexander, 49 years old, rheumatologist: “For various joint diseases, I often prescribe the drug Artra to my patients. If you take it for a long time, joint pain is greatly reduced. But the medicine is expensive and often irritates the stomach. Effective at the initial stage of joint disease.”

Marina, 52 years old, arthrologist: “Dona is the best chondroprotector, which I often prescribe to my patients. It shows good results, greatly reducing joint pain. The price of such a medicine is high, so few can purchase it, but the effect of its use is worth it.”

Comparison of side effects of Dona and Arthra

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Dona's state of adverse events is almost the same as Arthra's. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Dona are similar to Artra: how quickly the body recovers after taking it and whether it recovers at all.