International Journal of Research in Orthopaedics | July-August 2019 | Vol 5 | Issue 4 Page 753 International Journal of Research in Orthopaedics Kakatkar V et al. Int J Res Orthop. 2019 Jul;5(4):753-763 http://www.ijoro.org Review Article Adjuvant drugs in management of osteoarthritis: spotlight on type II collagen Vijay Kakatkar 1 , A. K. Pal 2 , Raghuveer Reddy 3 , Ravi Dashputra 4 , Sanjay Kamble 5 *, Hiten Saresa 5 , Rishi Jain 5 INTRODUCTION Osteoarthritis (OA) is the most common musculoskeletal degenerative disorder of articular cartilage that predominantly affects the weight-bearing joints (e.g. knees, hips, cervical and lumbosacral spine and feet). Recent pathological understandings elaborate that OA is not restricted to the articular cartilage but involves entire joint including the subchondral bone and synovium and thus it is defined as a collection of overlapping distinctive joint disorders which result in similar biological, morphological and clinical outcomes. 1 Interplay of various risk factors such as increasing age, obesity, joint malalignment, increased biomechanical loading of joints, genetics and as recently suggested, low-grade systemic inflammation are instrumental in OA. 2 Alterations in the articular cartilage, subchondral bone, ligaments, capsule and synovial membrane lead to loss of cartilage, osteophyte formation, subchondral bone changes and meniscal alterations. 3,4 This is associated with clinical symptoms of chronic pain, joint in-stability, stiffness and radiographic joint space narrowing. 5 Chronic low-grade joint inflammation and genetic predisposition have been identified as risk factors in OA. 6 ABSTRACT Osteoarthritis (OA) is a common musculoskeletal disorder that affects large and small joints and is seen in all ages due to diverse aetiologies. Pain, joint stiffness and limitation of daily activities affects the quality of life of individuals with OA. Conventional analgesics like non-steroidal anti-inflammatory drugs affect pain and inflammatory component but do not target the disease pathogenesis. Damage to the joint cartilage is central to the pathogenesis of OA. Better understanding of the pathogenesis has led to evolution of various adjuvant drugs in management of OA. Among them, undenatured type II collagen induces immune tolerance and thereby provide benefits by reducing the joint damage. Studies assessing efficacy and safety of undenatured type II collagen in OA have shown to reduce clinical symptoms like pain, joint stiffness and improvement in physical activities, and thus improving the quality of life. It is well tolerated and safe for use in OA. This article discusses the pathophysiology of OA with inflammation and beyond, and overviews the various drugs that are used as adjuvants in the management of OA with special focus on the use of type 2 collagen. Keywords: Type II collagen, Osteoarthritis, Inflammation, Pain, Quality of life, Adjuvant Department of Orthopaedics, 1 Ramkrishna Medical Research Centre, Nashik, Maharashtra, 2 SSKM Medical College, IPGMER, Kolkata, West Bengal, 3 Sai Institute of Sports Injury and Arthroscopy, Hyderabad, Telangana, 4 Dashputra Orthopedic Hospital, Nagpur, Maharashtra, India 5 Department of Medical Affairs, Wockhardt Ltd., BKC, Mumbai, Maharashtra, India Received: 29 March 2019 Revised: 18 May 2019 Accepted: 30 May 2019 *Correspondence: Dr. Sanjay Kamble, E-mail: skamble@wockhardt.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192698