#16
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Áîëüøîå ñïàñèáî çà èíôîðìàöèþ î òîì, ÷òî êíèæêè ïðîäàþòñÿ íà àìàçîíå - íèêîãäà áû ñàì íå äîãàäàëñÿ.
Áûëî áû åùå áîëåå ïðèÿòíî ïîëó÷èòü îò Âàñ îòâåò íà âîïðîñ, ãäå Âû âñòðå÷àëè èíîå îòíîøåíèå ê îáñóæäàåìûì ïðîäóêòàì, íåæåëè ïðèçíàíèå èõ ÁÀÄàìè? Íå çíàþ, ÷òî çàñòàâèëî Âàñ ïîñ÷èòàòü íåóâàæàåìûì èññëåäîâàíèå, ïðèâåäåííîå â NEJM, êñòàòè, ïðèçâàííîå èçíà÷àëüíî ïîääåðæàòü Âàøó òî÷êó çðåíèÿ (íåóæåëè Âàì íå ïîíðàâèëèñü âûâîäû â äàííîì òðàéëå è îòçûâû â ñòàòüÿõ ïî òåìå âíèçó òåêñòà?). Öèòàòà:
 öåëîì ñèòóàöèþ ìîæíî îïèñàòü òàêèì çàèìñòâîâàíèåì: Öèòàòà:
With an intensification of research in this field come new clinical and basic science data, sometimes with surprising results. These confirm the considerable potential for a role of nutritional interventions for osteoarthritis, but they emphasize the need for systematic scientific evaluation of the claims made for such products. (Èç ðå÷è âòîðîãî àâòîðà, èçó÷àþùåãî âëèÿíèå ïèùåâûõ äîáàâîê íà ëþäÿõ). PS: Ê óíûíèþ, â èíîì àñïåêòå äàííûå âåùåñòâà íèêåì íå ðàññìàòðèâàþòñÿ óæå ñåìü ëåò (åñëè êîíå÷íî, íå ññûëàòüñÿ íà ðóìûíñêèå èñòî÷íèêè). |
#17
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Óâàæàåìûå êîëëåãè,
Ïîæàëóé, ñàìîå ñâåæåå (íîÿáðü 2006) ïî òåìå îòñþäà: Comparative Effectiveness and Safety of Analgesics for Osteoarthritis: Executive Summary From AHRQ Agency for Healthcare Quality and Research (AHRQ) Ôðàãìåíò âûâîäîâ (ïîëíûé òåêñò) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Glucosamine and chondroitin In one large, good-quality trial the combination of pharmaceutical-grade glucosamine hydrochloride plus chondroitin (not currently available in the United States) was not superior to placebo among all patients studied. Neither glucosamine nor chondroitin alone was superior to placebo. In an analysis of a small subgroup of patients with at least moderate baseline pain, there was a modest benefit for pain relief, but this did not appear to be a preplanned analysis. Systematic reviews of older trials found glucosamine modestly superior to oral NSAIDs and placebo in most trials, but there was some inconsistency between trials, most trials had some flaws and results may not be directly applicable to the United States because the positive trials primarily evaluated pharmaceutical-grade glucosamine available in Europe. Only 2 of 20 placebo-controlled trials assessed effects of glucosamine on radiologic disease progression. One fair- and one good-quality trial found pharmaceutical-grade glucosamine superior to placebo for progression of knee joint space narrowing over 3 years. Glucosamine and chondroitin were generally well tolerated and no serious adverse events were reported in clinical trials.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#18
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Öèòàòà:
Harrison's Principles of Internal Medicine 16th Edition Several studies have shown glucosamine to be superior to placebo and comparable to NSAIDs37 with respect to efficacy in patients with knee OA, and to have a better safety profile than NSAIDs. However, the efficacy of neither glucosamine nor chondroitin sulfate has been examined in large, well-designed placebo-controlled trials. In a meta-analysis of randomized, double-blind, placebo-controlled studies of glucosamine and chondroitin sulfate, moderate symptomatic benefit was demonstrated for both agents, relative to placebo. In studies of chondroitin sulfate, symptomatic improvement was apparent as long as 12 months after the onset of treatment. However, when only high-quality or large-size trials were considered, the effect sizes for glucosamine and chondroitin sulfate were diminished, i.e., the better the study design, the smaller the therapeutic benefit. In three recent randomized, double-blind trials in which the manufacturer did not have access to the raw data and was not involved in data analysis, glucosamine was no more effective than placebo. The question arises whether glucosamine is "chondroprotective." Results of two recent randomized clinical trials have led to the suggestion that glucosamine not only improves joint pain in patients with knee OA1, but protects against articular cartilage damage, based upon analyses of changes in joint space width in the standing anteroposterior (AP) knee radiograph. However, concern has been expressed about the interpretation of the results of these studies because of limitations of the radiographic methods employed. A multicenter study supported by the National Institutes of Health, the Glucosamine Chondroitin Arthritis Intervention Trial (GAIT), is in progress which is comparing glucosamine, chondroitin sulfate, the combination, and celecoxib with placebo in patients with knee OA. Although the primary outcome measure is joint pain after 6 months of treatment, approximately 50% of the subjects will be maintained on treatment for 2 years and radiographs obtained at baseline will be compared with those obtained after 1 year and 2 years of treatment. Current Medical Diagnosis & Treatment 2007, Forty-Sixth Edition (öèòàòà âûøå) Diagnosis and treatment of adult degenerative joint disease (DJD) of the knee. GUIDELINE STATUS This is the current release of the guideline. The nutraceutical agents glucosamine (1500 mg qD) and chondroitin sulfate (1200 mg qD) are widely available and tried by patients. A systematic quality assessment and meta-analysis of double-blind, placebo-controlled trials that tested glucosamine or chondroitin for hip or knee osteoarthritis concluded that some degree of efficacy appears probable for these preparations. It is reasonable to recommend a 60-day trial of the combination of glucosamine and chondroitin sulfate, leaving the decision for ongoing (continuing) therapy to patients on an individual basis. Âîò òóò ÿ è õî÷ó ñäåëàòü íåáîëüøîå ðåçþìå - ÁÀÄû, êàê èçâåñòíî, íè÷åãî ëå÷èòü è ïðîôèëàêòèðîâàòü ïðàâà íå èìåþò, ïîýòîìó ðàññìîòðåíèå èõ â êà÷åñòâå ËÅ×ÅÍÈß (î âåëèêîé ýôôåêòèâíîñòè ãîâîðèòü íå ïðèõîäèòñÿ, íî è ñîâñåì ðàâíÿòü ñ ïëàöåáî òîæå) ÁÀÄàìè äàííûå âåùåñòâà íå äåëàåò. Âî ìíîãèõ ñòðàíàõ çàðåãèñòðèðîâàíû êàê ëåêàðñòâà Öèòàòà:
ß ïðèâåë òî÷íóþ öèòàòó òîãî, ÷òî ìíå ïîêàçàëîñü íåóâàæàåìûì, ýòî áûëà ññûëêà íà ôîðóì. Èññëåäîâàíèå ìíå èçâåñòíî, ÿ åãî óâàæàþ Öèòàòà:
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher Îíè íå â êóðñå |
#19
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#20
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#21
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Ñîâåðøåííî íàîáîðîò - ñâèäåòåëüñòâóþò îá îòñóòñòâèè äîêàçàòåëüñòâ ýôôåêòèâíîñòè - îáû÷íûå èñïûòàíèÿ áèîäîáàâîê ñ ýôåìåðíîé íàäåæäîé ïðîòîëêíóòü èõ â ðàçäåë ëåêàðñòâ.
À ïîñêîëüêó íèêàêîé ýôôåêòèâíîñòè â äåéñòâèè ãëþêîçàìèíîâ, õîíäðîèòèíîâ è ðîäñòâåííûõ èì âåùåñòâ äîêàçàíî íå áûëî, âñå ýòè âåùåñòâà, íåçàâèñèìî îò òîãî, íàçûâàþòñÿ îíè õîíäðîïðîòåêòîðàìè èëè ïðîñòî áèî-àêòèâíûìè àìèíîñàõàðàìè, ïðîèçâîäÿòñÿ èç êîðîâüèõ õðÿùåé èëè êðåâåòî÷íûõ õèòèíîâ, ïðîäàþòñÿ äëÿ ïîòðåáëåíèÿ áîëüíûìè ñ àðòðèòàìè èëè ïðîñòî "îò âñåõ áîëåçíåé", ÿâëÿþòñÿ "dietary supplements", "nutraceutical agents", "Alternative Medicine pills" è òîìó ïîäîáíûå ïóñòûøêè, âñåãäà îçíà÷àþùèå ÁÀÄû, òîëüêî ÁÀÄû è íè÷åãî, êðîìå ÁÀÄîâ (âíå ñâÿçè ñ òåì, ÷òî ïåðåïå÷àòûâàåòñÿ â Õàððèñîíå èç èçäàíèÿ â èçäàíèå íà ïðîòÿæåíèå äåñÿòêîâ ëåò). Ìîæåò áûòü, áîëåå óáåäèòåëüíûì ñòàíåò [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (Glucosamine and chondroitin sulfate are classified as a nutritional supplement - äàæå , êîãäà èìè êîðìÿò äîìàøíèõ ðó÷íûõ êðûñ ). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] (Ñì. "backgraund"; èç èñòîðèè: êîå-ãäå â Åâðîïå îíè ïîêà åùå îñòàþòñÿ òèïà ëåêàðñòâàìè...) |
#22
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Öèòàòà:
Äà? Åñòü ïðåòåíçèè ê äèçàéíó? Ê æóðíàëàì, èõ îïóáëèêîâàâøèì? Ê àìåðèêàíñêèì ðóêîâîäñòâàì ïî ÎÀ? Öèòàòà:
Äëÿ êîãî ÿ öèòèðîâàë: See Related Guideline from CURRENT Practice Guidelines in Primary Care 2006 Analgesic and Anti-inflammatory Drugs Nonsteroidal anti-inflammatory drugs (NSAIDs) (see Table 5–5) are more effective (and more toxic) than acetaminophen for osteoarthritis of the knee or hip. Their superiority is most convincing in those with severe disease. Patients with mild disease should start with acetaminophen (2.6–4 g/d). Glucosamine and chondroitin sulfate are also effective and safe for knee osteoarthritis; glucosamine may even reduce progression of knee osteoarthritis. NSAIDs should be considered for patients who do not respond to acetaminophen, chondroitin sulfate, and glucosamine. (See discussion of NSAID toxicity in the section on treatment of rheumatoid arthritis.) High doses of NSAIDs, as used in more inflammatory arthritides, are unnecessary. Ïðàâäà, õîíäðîïðîòåêòîðû, ñóäÿ ïî âñåìó, êàê è âñå îñòàëüíûå ëåêàðñòâà íå çàìåäëÿþò ïðîãðåññèðîâàíèÿ ÎÀ. Òåì íå ìåíåå, ó áîëüíûõ ÎÀ, èìåþùèõ äîâîëüíî ñêóäíûé âûáîð - ïàðàöåòàìîë, ÖÎÃ2-èíãèáèòîðû èëè òðàìàë +/ïàðàöåòàìîë, õîíäðîïðîòåêòîðû âïîëíå ÷åñòíî çàíÿëè ñâîþ òåðàïåâòè÷åñêóþ íèøó. Âåäü ÷òî âàæíî äëÿ ïðàêòè÷åñêîãî âðà÷à? Èñïîëüçóÿ äàííûå ñîâðåìåííûõ è êà÷åñòâåííûõ èññëåäîâàíèé, ëå÷èòü êîíêðåòíîãî áîëüíîãî, äîáèâøèñü ìèíèìóìà ïîáî÷íûõ ýôôåêòîâ. Ïîýòîìó ÍÈÊÒÎ, íè â ÑØÀ, íè â Ðîññèè ÍÅ ÎÑÓÄÈÒ ìåíÿ èëè åùå êîãî-ëèáî çà íàçíà÷åíèå àðòðû èëè ñòðóêòóìà. Öèòàòà:
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#23
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PS: Öèòàòà:
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#24
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#25
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Ýòî è åñòü òîò óðîâåíü èññëåäîâàíèé, êîòîðûé ïîçâîëÿåò âûïóñêàòü ñîîòâåòñòâóþùèå ïðåïàðàòû â âèäå ÁÀÄîâ è íèêàê íå äîïóñêàåò ñ÷èòàòü èõ ëåêàðñòâàìè (åñëè, êîíå÷íî, íå ïðîèçâîäèòü èõ â Ðîññèè è ðÿäå åâðîïåéñêèõ ñòðàí ñ çà÷àòî÷íî äîêàçàòåëüíûì çàêîíîäàòåëüñòâîì â ôàðì ñôåðå). |
#26
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Öèòàòà:
Öèòàòà:
Âñå-òàêè ïîëó÷àåòñÿ, ÷òî äàííûå âåùåñòâà - è åñòü ïðèìåð ÁÀÄîâ, êîòîðûå äîêàçàëè ñâîé òåðàïåâòè÷åñêèé ýôôåêò. Ê ñîæàëåíèþ, Âû îøèáàëèñü, êîãäà ïèñàëè, ÷òî ê íèì 7 ëåò êàê óæå ïîòåðÿëè èíòåðåñ , êàê è îøèáàëèñü â òîì, ÷òî îíè "åùå êîå-ãäå-òî-êàê-òî" íàçûâàþòñÿ ëåêàðñòâàìè . |
#27
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#28
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Öèòàòà:
ß ïðèâåë íåîáõîäèìûå äîêàçàòåëüñòâà, ÷òîáû äàòü ïîíÿòü - ýòî ÁÀÄàìè îíè ñ÷èòàþòñÿ åùå êîå-ãäå-òî-ïîðîé (ÿ íå íàñòîëüêî âåëèêèé ôàíàò ÑØÀ, ÷òîáû ñ÷èòàòü èõ áÎëüøåé ÷àñòüþ ìèðà ), à âî âñåì îñòàëüíîì ìèðå ýòî - ëåêàðñòâà. ×òî ñîâåðøåííî ÍÅ ÈÑÊËÞ×ÀÅÒ íåîáõîäèìîñòü ïîñòìàðêåòèíãîâûõ èññëåäîâàíèé. Äåéñòâèòåëüíî, ýâèäåíñ, êîòîðûé èãðàåò íà ðóêó õîíäðîïðîòåêòîðàì, ÿ áðàë èç àìåðèêàíñêèõ ðóêîâîäñòâ ïîòîìó, ÷òî îíè áîëåå óáåäèòåëüíû, à èõ àâòîðû - òðàäèöèîííî íàèáîëåå îñòîðîæíû â ñâîèõ âûâîäàõ è ñóæäåíèÿõ, ÷òî ìíå è íðàâèòñÿ. Åñëè íóæíî - ìîãó ïðèâåñòè ïóáëèêàöèè è äðóãèõ ñòðàí Êîíå÷íî, óäèâèòåëüíî, ÷òî, íåñìîòðÿ íà ìíîãî÷èñëåííûå óïîìèíàíèÿ â ðàçëè÷íûõ ðóêîâîäñòâàõ â ðàçäåëå "ËÅ×ÅÍÈÅ" èõ åùå íå ïðè÷èñëèëè ê ëåêàðñòâàì, íî ÷òî æ ïîäåëàòü - âðåìÿ ïîêàæåò. Öèòàòà:
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#29
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Âíèìàòåëüíî ÷èòàëà äèñêóññèþ...Âîò òàê äîëãî, íåêðàñèâî è ìó÷èòåëüíî ðîæäàåòñÿ èñòèíà !
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#30
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æàëêî íå âëàäåþ ëàòèíñêèì , íàâåðíî ìíîãî óïóñòèë
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