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1 관절염과건강기능식품 - 虛와實 경희대학교류마티스내과홍승재

4 건강기능식품 건강기능식품 인체에유용한기능성을가진원료나성분을사용하여제조ㆍ가공한식품을말한다 ( 법률제8941호 ) 원료부터생산에이르기까지식약청에서직접관리 건강기능식품의제조를위해서는엄격한시설과품질관리인력을갖추고식약청으로부터건강기능식품제조업허가를받아야함 건강기능식품의분류 식품의약품안전청장이기준 규격을미리정해놓은고시형제품 영양보충용제품, 인삼 홍삼제품, 글루코사민제품, EPA DHA제품, 감마리놀렌산, 키토산가공식품등 37종 개별적으로기능성을인정받은개별인정형제품

5 2008 년건강기능식품총생산액현황 총생산액 ( 억원 ) 구분 증가율 ( 08/ 07,%) 총액 6,856 7,008 7,234 8, 홍삼 1,920 2,469 3,284 4, 알로에겔 970 1, 비타민및무기질 개별인정형 인삼 오메가-3 지방산함유유지 글루코사민 프로바이오틱스 효모 클로렐라 식품의약품안전청, 2008 건강기능식품생산실적

6 2008 년건강기능식품총생산액현황 총생산액 ( 억원 ) 구분 증가율 ( 08/ 07,%) 총액 6,856 7,008 7,234 8, 감마리놀렌산함유유지 식이섬유 ( 보충용 ) 키토산 / 키토올리고당 스쿠알렌 효소 프로폴리스추출물 자라 스피루리나 단백질 버섯 식품의약품안전청, 2008 건강기능식품생산실적

7 건강기능식품의기능적구분 * 자료출처 : 식품의약품안전청

8 관절염에좋은건강기능식품? * 자료출처 : 식품의약품안전청

9 건강보조식품및민간요법실태 관절증상관련건강보조식품, 민간요법유무 건강보조식품, 민간요법만족도 80.0% 60.0% 40.0% 20.0% 0.0% 65.2% 30.1% 48.5% 45.6% 4.7% 5.9% 있다없다무응답 40.0% 30.0% 20.0% 10.0% 0.0% 37.0% 26.2% 33.7% 30.5% 15.2% 17.6% 15.2% 10.3% 4.4% 6.8% 2.0% 1.1% 효과가없다 점 점 점 점 2008(%) 2007(%) 기타곤충류홍화씨가루마늘엑기스석류벌침, 봉독인삼가공류태반주사동물류한약 ( 약국 ) 한약 ( 한의원 ) 악마의발톱항산화제비타민제제클로렐라녹즙계통오메가-3 초록잎홍합글루코사민, 콘드로이친 기타 : 2008(%) 2007(%) 꿀, 면역력강화건강보조식품, 민들레, 보행왕 ( 일본산 ), 사혈, 솔잎환홍초, 양파즙, 오가피청국장가루, 인진쑥, 추나요법, 침술, 콩보리가루, 홍삼칼슘 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 대한류마티스학회, 2009 류마티스 1,2,3 캠페인자료

10 건강보조식품및민간요법실태 건강보조식품구입한달비용 5% 4% 1% 0% 24% 66% 10만원미만 10-20만원 20-30만원 30-50만원 만원 100만원이상 대한류마티스학회, 2009 류마티스 1,2,3 캠페인자료

11 건강보조식품및민간요법실태 부작용의내용 간수치이상이있어복용중지 관절관련약을먹고배가아픔 두드러기 리프리놀복용하고다리가많이부었음 벌침및두드러기구토일으킴 변비 변비의효능에확실치않아병원치료중단으로관절염이심해짐 뼈가일어날수없을정도로너무아픔 속쓰림 구토 어지러움 가슴답답 신발깔창을사서신은후더걷기힘듬 증상이더심해짐 지네엑기스먹고부종 피부알러지 ( 봉독치료 ) 한약먹고위경련발생 한약을복용하고코피를많이흘림 대한류마티스학회, 2009 류마티스 1,2,3 캠페인자료

12 관절염과건강기능식품 골관절염 ( 퇴행성관절염 ) 과건강기능식품 류마티스관절염과건강기능식품 통풍과건강기능식품 강직성척추염과건강기능식품

13 References

14 Nutraceuticals = SYSADOA : symptomatic slow-acting drug for osteoarthritis = DMOAD : disease modifying osteoarthritis drug

15 Nutraceuticals = SYSADOA : symptomatic slow-acting drug for osteoarthritis = DMOAD : disease modifying osteoarthritis drug

16 골관절염과건강기능식품 Glucosamine & Chondroitin Diacerein Avocado-soybean unsaponifiables (ASUs) S-adenosylmethionine (SAMe)

17 Principal components of connective tissues

18 Representation of typical components of the extracellular matrix and their interactions with each other and with receptors on the cell surface. Components are not drawn to scale.

19 Glucosamine & Chondroitin Glucosamine Glucose + Amine Glycosaminoglycan 과 Proteoglycan 의구성성분 대부분의건강기능식품은조개, 갑각류의 Chitin 으로부터합성 Chondroitin Proteoglycan 의구성성분 상어나소의연골에서추출하여합성

20 Glucosamine & Chondroitin The Journal of International Medical Research 2008; 36:

Glucosamine & Chondroitin Oral glucosamine vs placebo glucosamine to be superior to placebo with a 28% improvement in pain and a 21% improvement in function using the Lequesne

21 Glucosamine & Chondroitin Oral glucosamine vs placebo glucosamine to be superior to placebo with a 28% improvement in pain and a 21% improvement in function using the Lequesne Index : Towheed et al. Cochrane Database Syst Rev 2005;2:CD 이후연구들은 failed to prove efficacy Placebo effect?? large observational study 필요!! Journal of Rheumatology, 2007; 34:9

22 N Engl J Med, 2006;354:

23 N Engl J Med, 2006;354:

24 Glucosamine & Chondroitin No treatment achieved at 2 years knees with K/L grade 2 radiographic OA appeared to have the greatest potential for modification Arthritis Rheum, 2008;58(10):

25 Glucosamine & Chondroitin No statistically significant improvement Osteoarthritis and Cartilage (2008) 16, S22eS24

26 Significant reduction in minimum joint space width loss in the CS group Pain improved significantly faster in the CS group Arthritis Rheum, 2009;60:524 33

27 이등, 대한류마티스학회지 2008;15:

28 이등, 대한류마티스학회지 2008;15:

29 이등, 대한류마티스학회지 2008;15:

Glucosamine & Chondroitin 18. Treatment with glucosamine and/or chondroitin sulphate may provide symptomatic benefit in patients with knee OA.

30 Glucosamine & Chondroitin 18. Treatment with glucosamine and/or chondroitin sulphate may provide symptomatic benefit in patients with knee OA. If no response is apparent within 6 months treatment should be discontinued. SOR: 63% 19. In patients with symptomatic knee OA glucosamine sulphate and chondroitin sulphate may have structure-modifying effects while diacerein may have structure-modifying effects in patients with symptomatic OA of the hip. SOR: 41%

31 Glucosamine & Chondroitin EULAR : SYSADOA (glucosamine sulphate, chondroitin sulphate, ASU, diacerein, hyaluronic acid) have symptomatic effects and may modify structure in knee OA OARSI: glucosamine sulphate and chondroitin sulphate: structure-modifying effects in symptomatic knee NICE : not recommended

32 Diacerein Diacerein vs NSAIDs In hip/knee OA similarly efficacy, diacerein showed a carryover effect up to 3 months Arch Intern Med, 2006;166: hip OA slowing X ray progression 입증 (vs knee OA에서는실패 ) adverse event : diarrhea (m/c) diacerein has a small, consistent benefit in improvement in pain Cochrane Database Syst Rev Jan 25;(1):CD005117

33 Diacerein 19. In patients with symptomatic knee OA glucosamine sulphate and chondroitin sulphate may have structure-modifying effects while diacerein may have structure-modifying effects in patients with symptomatic OA of the hip. SOR: 41%

34 Avocado-soybean unsaponifiables (ASUs) no worse and no better for treatment of OA than other medications pain and Lequesne index : favor ASU no evidence of significant adverse effects patients may be recommended to give ASU a chance for e.g., 3 months, after which a balanced review of the individual effect Osteoarthritis Cartilage 2008;16(4):

35 S-adenosylmethionine (SAMe) `````````````` Knee OA 에서 SAMe 와 celecoxib 16 주비교 SAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee OA BMC Musculoskelet Disord, 2004;5:6.

36 관절염과건강기능식품 골관절염 ( 퇴행성관절염 ) 과건강기능식품류마티스관절염과건강기능식품통풍과건강기능식품강직성척추염과건강기능식품

37 ω-3 불포화지방산 alpha-linolenic acid (ALA), Eicosapentaenoic acid C 20 H 30 O 2 Docosahexaenoic acid C 22 H 32 O 2.

38 ω-3 불포화지방산 / Perna canaliculus 작용 Anti-inflammatory action Leucocyte chemotaxis, production of reactive oxygen species and proinflammatory cytokines 을감소시켜줌 Perna canaliculus ( 초록잎홍합 ) Extract of New Zealand green-lipped mussel ω-3 PUFAs 이 25% 이상함유

39 Daily supplementation with 2.6 gm of ω3 results in significant pain improvement may reduce the need for concomitant antirheumatic medication Arthritis Rheum, 1994;37:824-9

40 관절염과건강기능식품 골관절염 ( 퇴행성관절염 ) 과건강기능식품류마티스관절염과건강기능식품통풍과건강기능식품강직성척추염과건강기능식품

41 통풍과건강기능식품 좋은군 유제품 비타민 C 커피 나쁜군 술 ( 맥주 > 양주 ) 육류, 해산물 과당이풍부한과일 이상한군 ( 차이없는군 ) 적당량의와인 고단백식이 고퓨린식이 ( 시금치, 렌즈콩 ) 다이어트탄산음료

42 커피섭취가증가할수록혈중요산농도가낮아진다. 차와는관련없다. 커피섭취와혈중요산농도의역상관관계는카페인때문은아니다. Arthritis Rheum 2007;57(5):816-21

43 J Rheumatol, 2008,35:1853-8

44 Vitamin C intake is strongly associated with a lower risk of gout. Increasing vitamin C intake may be beneficial in the prevention of gout. Arch Intern Med. 2009;169(5):502-7

45 관절염과건강기능식품 골관절염 ( 퇴행성관절염 ) 과건강기능식품류마티스관절염과건강기능식품통풍과건강기능식품강직성척추염과건강기능식품

46 ω-3 불포화지방산 / Perna canaliculus low-dose group (1.95 g ω-3/day) No significant decrease high-dose group (4.55 g ω-3/day) significant decrease in disease activity (BASDAI) larger controlled studies are needed!

47 Take home messages 골관절염 무릎 : glucosamine sulphate, chondroitin sulphate 고관절 : diacerein 류마티스관절염 ω-3 불포화지방산 통풍 유제품, 비타민 C, 커피 강직성척추염 ω-3 불포화지방산

48 References Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62: Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;2:CD Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006;354: Huskisson EC. Glucosamine and chondroitin for osteoarthritis. J Int Med Res 2008;36: Cobb CS, Ernst E. Systematic review of a marine nutriceutical supplement in clinical trials for arthritis: the effectiveness of the New Zealand greenlipped mussel Perna canaliculus. Clin Rheumatol 2006;25:275-84

Treatment and Role of Hormaonal Replaement Therapy

Treatment and Role of Hormaonal Replaement Therapy Treatment and Role of Hormone Replacement Therapy Chung-Ang University Hospital Chee Jeong Kim 7.2 5.3 6.4 5.6 7.3 5.5 1 1 2 3 4 10 11 7 34 49 122 123 1.0 - - 10. 2001 1998 1998 Improvement of postmenopausal