European investigators recently reported on a trial comparing the efficacy of pharmaceutical-grade chondroitin sulfate (CS) (800 mg/day) with the NSAID celecoxib (CX) (200 mg/day) and placebo in more than 600 patients with painful knee osteoarthritis (OA).
In this well-designed, well-executed, double-blinded, 3-armed trial, investigators tracked patient pain scores at baseline and at 1-month, 3-month and 6-month intervals. This trial was characterized by strict adherence to blinded protocols, high levels of patient adherence, and meticulous review of patient diaries and adverse-event reports.
Patients in both the CS and CX groups experienced significantly greater pain relief when compared to those in the placebo group at every follow-up time point. In addition to tracking pain via the visual analogue scale (VAS), the investigators included the Lequesene index (LI)—which integrates both pain and function—along with the Minimal-Clinically Important Improvement (MCII) scale. While CX and CS were not superior/inferior to one another, both active treatments provided significant pain improvements relative to placebo according to all three measurements at all time points.
These findings showing the efficacy of pharmaceutical-grade CS are important for orthopaedic surgeons, rheumatologists, and general practitioners. Nonoperative management of knee OA remains an important modality that requires a multimodal approach, typically including NSAIDs and/or acetaminophen. These results suggest that there’s another safe medication that may prove especially helpful for OA patients who cannot tolerate NSAIDs or acetaminophen due to kidney, gastrointestinal, cardiovascular, and/or liver issues.
Richard Yoon, MD is a fellow in orthopaedic traumatology and complex adult reconstruction at Orlando Regional Medical Center.
Add findings from a recent study in Arthritis & Rheumatology to the growing body of evidence indicating that glucosamine and chondroitin supplements have no measurable impact on relieving knee osteoarthritis (OA). These findings add support to existing guidelines that recommend against the use of these supplements for OA treatment (see related OrthoBuzz article).
Utilizing a so-called “new user” design, researchers analyzed four-year follow-up data on more than 1,600 people who were not using glucosamine/chondroitin at baseline. In addition to measuring joint space width, researchers captured knee symptoms with WOMAC pain, stiffness, and function scales. They also employed marginal structural models to control for time-varying confounders. In the end, there were “no clinically significant differences” between supplement users and non-users, and the study authors claimed that, in addition to being consistent with meta-analyses of glucosamine/chondroitin, these findings extend the data set to include “a more general population with knee OA.
The Choosing Wisely campaign seeks to bring more awareness to tests and procedures that should be discussed between physicians and patients. The campaign was spearheaded by the ABIM Foundation, and the American Academy of Orthopaedic Surgeons (AAOS) partnered with the campaign to develop a list of the five things physicians and patients should question.
- Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.
- Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.
- Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.
- Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.
- Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.
The list was developed after review of approved clinical practice guidelines and included input from specialty society leaders.