Combination therapy for exacerbations of pain in osteoarthritis with non-fixed combinations; Комбинированная терапия обострений болевого синдрома при остеоартрите не фиксированными комбинациями

Aim. To evaluate the efficacy of a combination therapy containing chondroitin sulfate (CS), glucosamine (GL), methylsulfonylmethane (MSM), hyaluronic acid (HA), and native/hydrolyzed collagen compared to collagenfree therapy in the initial management of knee osteoarthritis (OA) exacerbations. Materials and methods. A singlecenter, prospective, comparative phase IV study included 60 patients with knee OA (Kellgren–Lawrence stages 2–3). Participants were randomized into two groups: Group A (n=30) received CS/GL/MSM/HA, while Group B (n=30) received the same regimen supplemented with collagen. Pain dynamics (VAS, WOMAC), NSAID requirements, and functional outcomes (Timed UpandGo test, walking speed, muscle strength) were assessed at weeks 1, 2, 4, and 8. Results. Group B demonstrated significant superiority: a 76% reduction in WOMAC pain scores (vs. 47% in Group A; p=0.04) and a 74% reduction in VAS scores (vs. 56%; p<0.05). NSAID use at week 8 was 2.6±0.5 days in Group B (vs. 4.3±1.8 in Group A; p=0.04). Functional improvements (12% increase in walking speed, 42% reduction in Timed UpandGo test duration) were also more pronounced in Group B (p<0.05). Conclusion. The combination of CS/GL/MSM/HA with collagen significantly outperforms collagenfree therapy in reducing pain, improving joint function, and decreasing symptomatic treatment needs in patients with knee OA exacerbations. These findings support the inclusion of collagen in OA combination therapy. © 2025 Elsevier B.V., All rights reserved.