Glucosamine and Chondroitin for Treatment of Osteoarthritis
ALTERNATIVE MEDICINE
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Glucosamine and Chondroitin for Treatment of Osteoarthritis
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FIRST OF TWO STUDIES

 

From WebMD

Supplements May Help Knee Arthritis

New Studies Give Mixed Signals About Glucosamine, Chondroitin Benefits


 

Glucosamine + Chondroitin: For Bad Arthritis Pain Only?

 

The U.S. trial enrolled patients aged 40 and older with knee pain due to osteoarthritis. They were randomly assigned to one of five treatments:

  • Inactive placebo pills
  • Glucosamine hydrochloride at a dose of 500 milligrams three times a day
  • Sodium chondroitin at a dose of 400 milligrams three times a day
  • Combination glucosamine and chondroitin
  • Celebrex at a dose of 200 milligrams per day

It is common for a pain study to show that many patients report relief from inactive placebo pills. And that happened here. Nearly 60% of patients given only placebo pills said they had less pain. So did about 67% of patients treated with combination glucosamine and chondroitin. But that isn't what scientists call a significant difference -- that is, there's more than a 7% chance the findings are just coincidence.  {The point is that for one in 20 feeling a bit more relief from pain isn’t worth 6 pills a day and a hundred dollars a month.  If codiene worked in just 7% of the cases and only somewhat, would it be taken for chronic pain?}

"I really feel the study is a negative study," Clegg says. "I would say to patients that the safety data are really reassuring, the efficacy data are not."

When Clegg's team looked only at patients with moderate to severe pain. Only 54% of these patients got relief from placebo. But 79% reported relief from combination glucosamine and chondroitin. That is a significant difference. But there's a problem, Clegg says. The study wasn't designed to look at just this group. The effect here is based on only a small number of patients.

"About 20% of the study patients have moderate to severe pain," Clegg says. "Interestingly, in that subgroup, the combination of glucosamine and chondroitin appeared to be effective in relieving pain. I think this outcome is really interesting but just from a research standpoint. It is an exploratory, hypothesis-generating finding -- not a finding on which to base treatment."

{While there is other studies supporting their effectiveness, none are that postive as to eliminate the placebo effect.  When an innert placebo is given, the very taste of the pill is enough to inform its taker which arm of the test they are in.  A percentage of those tested will perform a taste test to satisfy their curiosity.  Thus every test when the control group receives an innert tasting placebo, it will demonstrate effectiveness, when the measure of effectiveness is self-reporting.}

 SECOND STUDY

 

What the pharmaceutical industry does for drug research, those that promote alternative treatments do the same—and they have less scrutiny.  Below is a meta-study done to evaluate glucosamine and chondrotin (very popular, alternative arthritis treatment).  Quantifiable results were not possible because of experimenter bias.

 

Glucosamine and Chondroitin for Treatment of Osteoarthritis

A Systematic Quality Assessment and Meta-analysis

Timothy E. McAlindon, DM; Michael P. LaValley, PhD; Juan P. Gulin, MD; David T. Felson, MD

JAMA. 2000;283:1469-1475.

Context  Glucosamine and chondroitin preparations are widely touted in the lay press as remedies for osteoarthritis (OA), but uncertainty about their efficacy exists among the medical community.

Objective  To evaluate benefit of glucosamine and chondroitin preparations for OA symptoms using meta-analysis combined with systematic quality assessment of clinical trials of these preparations in knee and/or hip OA.

Data Sources  We searched for human clinical trials in MEDLINE (1966 to June 1999) and the Cochrane Controlled Trials Register using the terms osteoarthritis, osteoarthrosis, degenerative arthritis, glucosamine, chondroitin, and glycosaminoglycans. We also manually searched review articles, manuscripts, and supplements from rheumatology and OA journals and sought unpublished data by contacting content experts, study authors, and manufacturers of glucosamine or chondroitin.

Study Selection  Studies were included if they were published or unpublished double-blind, randomized, placebo-controlled trials of 4 or more weeks' duration that tested glucosamine or chondroitin for knee or hip OA and reported extractable data on the effect of treatment on symptoms. Fifteen of 37 studies were included in the analysis.

Data Extraction  Reviewers performed data extraction and scored each trial using a quality assessment instrument. We computed an effect size from the intergroup difference in mean outcome values at trial end, divided by the SD of the outcome value in the placebo group (0.2, small effect; 0.5, moderate; 0.8, large), and applied a correction factor to reduce bias. We tested for trial heterogeneity and publication bias and stratified for trial quality and size. We pooled effect sizes using a random effects model.

Data Synthesis  Quality scores ranged from 12.3% to 55.4% of the maximum, with a mean (SD) of 35.5% (12%). Only 1 study described adequate allocation concealment and 2 reported an intent-to-treat analysis. Most were supported or performed by a manufacturer. Funnel plots showed significant asymmetry (P .01) compatible with publication bias. Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The aggregated effect sizes were 0.44 (95% confidence interval [CI], 0.24-0.64) for glucosamine and 0.78 (95% CI, 0.60-0.95) for chondroitin, but they were diminished when only high-quality or large trials were considered. The effect sizes were relatively consistent for pain and functional outcomes.

Conclusions  Trials of glucosamine and chondroitin preparations for OA symptoms demonstrate moderate to large effects, but quality issues and likely publication bias suggest that these effects are exaggerated. Nevertheless, some degree of efficacy appears probable for these preparations.


Author Affiliation: The Arthritis Center, Boston University School of Medicine, Boston, Mass.


 

 

THIRD STUDY
 
OTHER STUDIES CONFIRM THE SAME.  IN FACT ONE META STUDY PLACED THOSE CLAIMING IMPROVEMENT AT 39% FOR GLUCOSAMINE AND 40% FOR CHONDROITIN
 

Rheum Dis Clin North Am. 1999 May;25(2):379-95.

Related Articles, Links


Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate.


Deal CL, Moskowitz RW.

Division of Rheumatology, Case Western Reserve University School of Medicine, University Hospitals, Cleveland, Ohio, USA.

Division of Rheumatology, Case Western Reserve University School of Medicine, University Hospitals, Cleveland, Ohio, USA.

 

There are a sufficient number of short-term studies with these agents suggesting efficacy equal to that seen in the symptomatic treatment of OA using NSAIDs. Two recent meta-analyses by McAlindon and colleagues and Towheed et al reviewed clinical trials of glucosamine and chondroitin in the treatment of osteoarthritis. The study by McAlindon and co-workers included all double-blind placebo-controlled trials of greater than 4 weeks' duration, testing oral or parenteral glucosamine or chondroitin for treatment of hip or knee osteoarthritis. Thirteen trials (six with glucosamine, seven with chondroitin) met eligibility criteria. The authors used global pain score or the Lequesne index in the index joint as the primary outcome measure and considered the trial positive if improvement in the treatment group was equal to or greater than 25% compared with the placebo group, and was significant (P < or = .05). All 13 studies reviewed were classified as positive, demonstrating large effects, compared with placebo (39.5% [S.D. 21.9] for glucosamine, 40.2% [S.D. 6.4] for chondroitin). The authors concluded that clinical trials of these two agents showed substantial benefit in the treatment of osteoarthritis but provided insufficient information about study design and conduct to allow definitive evaluation. Towheed and colleagues reviewed nine randomized, controlled trials of glucosamine sulfate in osteoarthritis. In seven of the randomized controlled trials, in which they compared glucosamine with placebo, glucosamine was always superior. In two randomized controlled trials comparing glucosamine to ibuprofen, glucosamine was superior in one and equivalent in one. Methodologic problems, including lack of standardized case definition of osteoarthritis and lack of standardized outcome assessment led the authors to conclude that further studies are needed to determine if route of administration is important and whether the therapeutic effect is site specific. A meta-analysis of chondroitin sulfate trials has also been published. Of the 12 published trials, 4 randomized double-blind placebo or NSAID-controlled trials with 227 patients on chondroitin sulfate were entered into the analysis. All four studies showed chondroitin sulfate to be superior to placebo, with respect to Lequesne index, visual analog scale for pain and medication consumption. Significant changes (P < or = .05) were seen in those treated from day 60 to the study endpoints (150 to 180 days). Pooled data demonstrated at least 50% improvement in the study variables in the chondroitin treated group. Discrepancies in some of the study findings reported in the literature may relate to the composition of the nutritional supplements used. Studies in the United States have revealed that a number of preparations claiming to contain certain doses of glucosamine or chondroitin sulfate have significantly less (or none) of the dosages described. Accordingly, it is essential that studies performed with these agents use preparations that are carefully defined in manufacture. The amounts generally administered are glucosamine, 1500 mg, and chondroitin sulfate, 1200 mg, daily. Although glucosamine has been described as effective when used alone, it is probably reasonable to use the combination pending further studies. The average cost is approximately $30 to $45 per month. In the interim, what should physicians tell their patients when they ask whether these agents are effective, or whether they should or should not take them? The authors emphasize that these agents are not FDA-evaluated or recommended for the treatment of OA. They are available as health food supplements, and the number of studies of toxicity, particularly with respect to long-term evaluations, is limited. The pros and cons of these agents and the published data are described so that patients can make a reasonably informed decision as to whether they wish to proceed with use of these agents in therapy. (ABSTRACT TRUNCATED)

 

 

 

Alternative medicine is like religion: faith, spurious claims, and damn the best reasoned conclusion.