Use of glucosamine and chondroitin to treat osteoarthritis: a review of the literature

Lopes Júnior, Osmar Valadão; Inácio, André Manoel

doi:10.1016/j.rbo.2012.09.007

Brasil

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Review Article • Rev. bras. ortop. 48 (4) • Aug 2013 • https://doi.org/10.1016/j.rbo.2012.09.007 linkcopy

Use of glucosamine and chondroitin to treat osteoarthritis: a review of the literature^⋆

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To evaluate the current evidence that support or disprove the use of glucosamine and chondroitin in the treatment of patients with osteoarthritis. We performed a literature review using the databases of Medline, PubMed and the Cochrane Controlled Trial Register and Cochrane Databases Systematic Reviews (Cochrane Library).We considered only studies with high level of evidence.The study included analysis of randomized controlled trials that included at least 100 patients in each intervention group, meta-analyzes and systematic reviews. Seven meta-analysis, one systematic review and five randomized clinical trials fit inclusion criteria of this review. Considering the best evidences until now, the use of glucosamine and chondroitin does not provide clinical relevant benefits to patients with osteoarthritis of the knee or hip (Level I of evidence and grade A of recommendation). Further trials with adequate technology are necessaries to elucidate this question.

Chondroitin; Glucosamine; Osteoarthritis; Review

Study (ref#)	Level of evidence	Type of study	Parameters evaluated	Results and conclusions
[24]	1A	Meta-analysis (10 RCTs) N = 3,803 GS/GH, CS vs placebo	Pain (VAS)	GS/ GH and CS did not reduce pain and did not have any impact on narrowing of the joint space.
[15]	1A	Systematic review (25 RCTs) GS vs placebo	Pain/Function Structural effects	The studies without conflicts of interest did not demonstrate any benefits from using GS.
[25]	1A	Meta-analysis 15 studies GH, GS	Pain	Heterogenous studies. Conflicts of interest. Greater effects in studies with conflicts of interest.
[31]	1A	Meta-analysis 6 systematic reviews 1 guideline GS/GH, CS	Pain Joint space Cost effectiveness	GS presented better clinical results. Cost effectiveness not detailed clearly.
[26]	1A	Meta-analysis (6 RCTs) N = 1,502 GS and CS	Joint space	GS and CS delayed the progression of osteoarthrosis after 2-3 years. Slight effects.
[27]	1A	Meta-analysis 20 RCTs N = 3,846 CS vs placebo	Pain	Majority of the studies presented delineation errors. CS did not present any benefits.
[18]	1A	Meta-analysis 15 RCTs GS and CS	Pain/Different parameters evaluated	Only one study presented clarity regarding allocation. Majority of the studies presented conflicts of interest. GS/CS was effective for pain control and improvement of function.
[17]	1A	Meta-analysis GS and CS	Joint space	Functional scores GS was effective with regard to all the parameters evaluated; CS was not shown to be effective in delaying the radiological evolution. Further studies are needed.

Study (ref#)	Level of evidence	Type of study	Parameters evaluated	Results and conclusions
[22]	1A	RCT, controlled, DB N = 1,583 GH, CS, GH+CS, celecoxib, placebo Expected improvement effect	WOMAC with pain Evaluation after 4, 8, 16 and 24 months	GH, CS or GH+CS did not reduce the pain in patients with osteoarthrosis. GH+CS was able to diminish the pain in patients with moderate to severe arthrosis.
[19]	1A	RCT, controlled, DB N = 212 GS 1,500 mg/day/3 years vs placebo Allocation not detailed	Medial joint space WOMAC	GS smaller loss of joint space (p = 0.043). Slight clinical improvement (p = 0.020). Irrelevant clinical difference. Conflicts of interest.
[19]	1A	RCT, controlled, DB N = 202 GS 1,500 mg/day/3 years vs placebo	Medial joint space Womac Lequesne	GS smaller loss of joint space (p = 0.001). Slight clinical improvement 20-25%. Irrelevant clinical difference. Conflicts of interest.
[29]	1A	RCT, controlled, DB N = 186 GS 1,500 mg/day/12 weeks vs placebo	Womac Pain and stiffness Functional score	GS and placebo without difference. Short follow-up.
[30]	1A	RCT, controlled, DB N = 622 CS 800 mg/day/24 weeks vs placebo	Pain Medial joint space	CS promoted improvement of pain and smaller loss of medial joint space.

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Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[TFN01t01] CS, chondroitin sulfate; RCT, randomized clinical trial; GH, glucosamine hydrochloride; GS, glucosamine sulfate; VAS, pain assessment using a visual analogue scale. Cochrane: review published in the Cochrane Library. NSAIDs, non-steroidal anti-inflammatory drugs

Use of glucosamine and chondroitin to treat osteoarthritis: a review of the literature⋆

Use of glucosamine and chondroitin to treat osteoarthritis: a review of the literature^⋆