Del Río Eloy
Independent Researcher, 11520 Cádiz, Spain.
Pharmacy (Basel). 2025 Aug 1;13(4):106. doi: 10.3390/pharmacy13040106.
Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection-illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication-and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical "What-How-When" framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4-4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways-supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide.
骨关节炎（OA）仍然是导致疼痛和残疾的主要原因；然而，目前的治疗主要是对症治疗，侧重于症状而非预防不可逆的软骨损失。本综述首先研究了药物性软骨保护的机制基础——阐述了硫酸葡萄糖胺和硫酸软骨素等传统药物如何可能恢复细胞外基质（ECM）成分、减弱分解代谢酶活性以及增强关节润滑——并探讨了无血管软骨和滑膜扩散屏障带来的给药挑战。随后，引入了一个实用的“是什么-怎么做-何时做”框架，以指导社区药剂师进行风险筛查、选择疾病修饰抗风湿药物（DMOAD）、时辰治疗给药、安全监测以及融入生活方式，以针对不同健康素养水平设计的CHONDROMOVING信息图表手册为例。基于这些策略，提出了P4-4P软骨保护框架，将预测性风险评估（医生）、预防性药代动力学和时辰治疗优化（药剂师）、个性化生物力学干预（物理治疗师）以及参与性自我管理（患者）整合到一个统一的、反馈驱动的OA护理模型中。为了将该框架转化为常规实践，我建议制定特定于DMOAD的临床指南，将软骨保护时辰治疗和跨专业协作纳入健康专业课程，并建立多学科OA管理途径——由适当的报销结构支持，以支持预防性的、基于团队的管理，并优先开展大规模随机试验和真实世界证据研究，以验证同步DMOAD和运动定时干预对长期结构、功能和生活质量的益处。这种全面的、精准驱动的模式旨在将OA护理从反应性缓解转变为真正的疾病修饰，保护软骨完整性并改善全球数百万人的生活质量。
